Severe acute respiratory syndrome novel coronavirus (SARS-CoV-2) has rapidly progressed from an outbreak to a global pandemic, with new variants emerging rapidly. Coronavirus disease 2019 (COVID-19), a disease caused by SARS-CoV-2 infection, can lead to multiorgan damage. Due to the highly contagious and fatal nature of the virus, the priority of medical research has been to find effective treatments. Amid this search, the role of vitamin D in modulating various aspects of the innate and adaptive immune system has been debated.The aim of the work: research on the role of vitamin D in the treatment and prevention of COVID-19. Although there are some conflicting results, the consensus is that vitamin D has a number of immunomodulatory effects that may be beneficial in the context of COVID-19 and that low vitamin D levels may result in dysfunction of key antimicrobial effects, potentially contributing to a poor prognosis. The aim of the paper is to investigate the impact and importance of vitamin D in patients with the corona virus.Work methods: During this retrospective study, data were taken from the Registry of those tested for the presence of the SARS-CoV2 virus, Specialist Center "Health House" in Bijeljina. The research included 30 patients positive for the presence of the SARS-CoV2 virus and 30 patients negative for the presence of the SARS-CoV2 virus. The following parameters were observed in the research: age, gender and vitamin D values, data on the body temperature of the patients and the duration of the disease, as well as the obtained results of the inflammatory parameters (Leukocytes and C- reactive protein CRP). The dana of all patients are anonymous. All patients were tested using the molecular method of polymerase chain reaction known as RT-PCR (Reverse transcription polymerase chain reaction). Separate samples were tested with Arhitectt Vitamin D reagent by the chemiluminescence method (CMIA), manufactured by Abott Arhitectt and 1000sr. Reference values of Vitamin D are from 75 to 150 nmol/L.Results: The concentration of vitamin D was lower in the group of patients with the coronavirus disease (COVID-19) compared to individuals with the absence of the coronavirus disease. There is a tendency towards a negative correlation between the concentration of vitamin D and the duration of the disease in the group of patients with the coronavirus disease (COVID-19), as like as the concentration of vitamin D and body temperature in the group of patients with the coronavirus disease (COVID-19). There is also a tendency towards a negative relationship between the concentration of vitamin D and parameters of inflammation (CRP, Le) in the group of patients with coronavirus disease (COVID-19).

Backround : Surgical site infection (SSI) is defined as an infection occurring within 30 days after a surgical operation and affecting either incision or deep tissues at the operation site. The aim of this study was to examine the incidence, identify bacterial agents and determine their antibiotics sensitivity of SSI following cesarean section (CS). Methods : This retrospective cohort study included women who undervent Misgav-Ladach method CS after which a SSI developed during the period from 01 January 2019 to 31 December 2019 at the Clinic for Gynecology and Obstetrics, University Clinical Center Tuzla. Results : During the observed period we recorded 3345 deliveries, out of which 946 (28.3%) were by cesarean section, and out of which 50 (5.28%) was with SSI. The most commonly isolated bacteria from SSI were: Escherichia coli ; Enterococcus faecalis ; Staphylococcus aureus ; Klebsiella pneumoniae . Fluoroquinolnes had the highest antibacterial activity against gram-positive pathogenes isolated. Staphylococcus aureus isolates is highly resistant to penicilline (100%). Conclusions : The prevalence of SSI following cesarean section was high and Enterococccus faecalis and Escherichia coli was the commonest pathogens isolated.

Aim To characterize methicillin-resistant S. aureus (MRSA) strains phenotypically and genotypically and to determine their clonal affiliation, representation and antibiotic resistance profile. Methods A total of 62 randomly selected MRSA isolates of different clinical samples collected from 2009 to 2017 were phenotypically and genotypically analysed. Phenotypic analyses were performed by standard microbiological procedures, and using VITEK 2/AES instrument as well as MALDI-TOF (matrix-assisted laser desorption/ionization) technology. Genotypic characterization included spa, MLST (multilocus sequence typing) and SCCmec typing, and detection of the Panton-Valentine leukocidin (PVL) and other enterotoxin encoding genes. Results The largest number of isolates, 21 (33.87%) belonged to ST228-MRSA-I, spa type t041, t1003 and t001. Other major clones were: ST239-MRSA-III, spa type t037 and t030 (27.41%); ST8-MRSA-IV, spa type t008 and t121 (12.9%); ST247-MRSA-I, spa type t051 (4.83%). PVL was detected in 10 isolates (SCCmec IV/V). During 2009 and 2010 the most frequent MRSA strain was South German clone, ST228-MRSA-I (80% and 90%, respectively), while in later years it was replaced with Brazilian-Hungarian clone ST239-MRSA-III (75% in 2015 and 2016). The South German clone, spa type t041 in 90.48% of cases was resistant to clindamycin, ciprofloxacin, erythromycin, cefoxitin, gentamicin, kanamycin, tobramycin and penicillin, while 70.58% samples of the Brazilian-Hungarian clone spa type t037 were additionally resistant to tetracycline and rifampicin. Conclusion This research can supplement the existing knowledge about the clonal distribution of MRSA in Bosnia and Herzegovina and their sensitivity to antibiotics in order to improve the national control of these infections.

Purpose: To report a rare occurrence of ocular dirofilariasis in Bosnia and Herzegovina and provide a short overview on clinical characteristics and treatment options for ocular dirofilariasis. Methods: A 75-year-old woman was admitted to the University Clinical Centre Tuzla with pain and redness in her left eye. A live, white, coiled, and active worm was noticed in subconjunctival space of bulbar conjunctiva. Results: After successful surgical extraction, the parasite was identified as the adult form of Dirofilaria repens. There were no signs of intraocular or systemic inflammation. Conclusion: Ophthalmologists should have in mind a possible infestation, especially in cases with repeated inflammatory reactions and swelling of the ocular region, which does not respond to conventional therapy.

Introduction: Leptospirosis is an infection caused by spiral bacteria from the family Leptospiraceae, and is considered to be the most widespread zoonosis in the world. Aim: To analyze the clinical and laboratory characteristics of patients with Leptospirosis over five years. Methods: The study included 160 patients aged 17-79 years, who in the period 01.01.2014. to 21.12.2018. were hospitalized at the Clinic for Infectious Diseases of the University Clinical Center Tuzla. They were diagnosed based on medical history, clinical examination, laboratory and microbiological results. The definitive diagnosis was confirmed by serological testing from the patients’ blood. Results: In the observed period, the highest number of patients were in 2014 80/160, and the lowest in 2015 15/160. Male patients were more likely to suffer from 118 (73.8%) than female 42 (26,3%). The mean age was ±56.5 years. The most common symptoms in patients were: fever (95,6%), headache (93,8%), malaise (87,5%) and myalgia (85,6%). In all patients, 160/160 (100%) accelerated erythrocyte sedimentation and elevated C-reactive protein was observed. The following findings were reported from white blood cell findings: leukocytosis in 81/160 (50,6%), neutrophilia in 103/160 (64,4%) and lymphopenia in 128/160 (80%) patients. Liver findings had the following values: elevated AST in 142/160 (88%) and ALT in 130/160 (81,3%) patients. Total bilirubin was elevated in 105/160 (65,6%) and direct in 107/160 (66,9%). Thrombocytopenia was in 142/160 (88%) patients. Urea was elevated in 103/160 (64,4%) and creatinine in 101/160 (61,3%) patients. Conclusion: it is very important that physicians in their day to day practice, especially in ambiguous febrile conditions, differentially diagnose leptospirosis and establish a timely diagnosis, this is ley to adequate and timely therapy, and therefore to reducing to development of complications and mortality.

Background: Colonization is the presence of bacteria in the intestines, skin, nose, throat or anywhere in the human body without any signs of infection but with increased risk for spreading bacteria to other patients and the emergence of new infections. Screening of colonized patients is used as part of the prevention and control of multidrug-resistant (MDR) infections caused by agents such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and multi-resistant Gram-negative bacteria. Material and methods: Data from 169 screened respondents hospitalized at the University Clinical Center Tuzla, between October 1, 2018, and May 1, 2019, were analyzed. Swabs were taken from nostrils, throat, axilla and groin area for all patients, and also from the anorectal area for 157 of them. Identification of MDR bacteria was done by phenotypical methods, according to the recommendations of EUCAST Clinical Breakpoint Table v.8.0, 2018. Results: Out of 169 patients, negative screening test results were found in 93 examinees (55.02%), and positive in 76 (44.97%). The largest number of patients undergoing screening was hospitalized in the Intensive Care Unit (Surgical Block), 73/169 (43.19%). The average screening time was 2.2 days or 53 hours. In 18/76 (23.68%) of patients with positive screening, prior to screening regular microbiological testing was done, and in the remaining 58/76 (76.3%) screening was performed first. Analyzing respondents with positive screening, 27 (35.53%) had negative findings during regular microbiological testing of different biological samples and for 49 (64.47%) different/same strains of MDR bacteria were isolated.Conclusion: Knowing the phenotypic profile of bacteria colonizing patients in intensive care units is a very useful tool in preventing their spread intra- and inter-hospitals.

Aim To determine the prevalence rate and resistance profile of Streptococcus agalactiae (S. agalactiae) in vaginal swabs of pregnant and adult non-pregnant women in the Tuzla region, Bosnia and Herzegovina (B&H), as well as its association with other aerobic bacteria. Methods This prospective study included 200 women, 100 pregnant and 100 adult non-pregnant. The research was conducted at the Institute of Microbiology, University Clinical Center Tuzla from October to December 2015. Standard aerobic microbiological techniques were used for isolation and identification of S. agalactiae and other aerobic bacteria. Antimicrobial susceptibility was determined by the disk diffusion and microdilution method(VITEK 2/AES instrument). Results Among 200 vaginal swabs, 17 (8.50%) were positive for S. agalactiae, e. g., 7% (7/100) of pregnant and 10% (10/100) of adult non-pregnant women. In the pregnant group, 71.4% (5/7) of S. agalactiae isolates were susceptible to clindamycin and 85.7%(6/7) to erythromycin. In the adult non-pregnant group, only resistance to clindamycin was observed in one patient (1/10; 10%). S. agalactiae as single pathogen was isolated in 57.14% (4/7) of pregnant and 60% (6/10) of adult non-pregnant S. agalactiae positive women. In mixed microbial cultures S. agalactiae was most frequently associated with Enterococcus faecalis and Escherichia coli. Conclusion The rate of S. agalactiae positive women in the population of pregnant and adult non-pregnant women of Tuzla Canton, B&H is comparable with other European countries. Large studies are needed to develop a common national strategy for the prevention of S. agalactiae infection in B&H, especially during pregnancy.

Background: The increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections lacking risk factors for exposure to the health care system has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). These strains have been distinguished from health care-associated MRSA (HA-MRSA) strains by epidemiological, molecular and genetic means as well as by antibiotic susceptibility profile, tissue tropism and virulence traits. Objective: To assess prevalence and antibiotic susceptibility profile of CA-MRSA in Canton Sarajevo, Bosnia and Herzegovina. Results: Out of 1.905 positive Staphylococcus aureus isolates from various samples of outpatients collected during six months, 279 (14,64%) were MRSA isolates. Out of 279 MRSA samples, 133 (47,67%) were found in nasal swabs, from which 48 (36,09%) were in the age group <1 year and 39 (29,32 %) are in the age 1-5 year. Rate of the positive skin swabs was highest among the subject of age group <1 year (46 or 54,12 %) and 1-5 year (18 or 21,18 %). Predominantly antibiotic types among MRSA strains are resistant to penicillin and cefoxitin (36,90 %) and to penicillin, cefoxitin and erythromycin (61,35 %). Conclusion: Continued monitoring of epidemiology and emerging drug resistance data is critical for the effective management of these infections.

Introduction: The finding of reduced value of immunoglobulin A (IgA) in children is frequent in daily medical practice. It is important to correctly interpret the findings as adequate further diagnostic evaluation of the patient in order to make the determination on the significance of such findings. In children younger than 4 years always consider the transient impairment of immunoglobulins, maturation of child and his immune system can lead to an improvement in the clinical picture. In older children decreased IgA may lead to serious illnesses that need to be recognize and acknowledge through the appropriate diagnostic methods. Material and methods: Research was realized at the University Clinical Center Tuzla. Children with suspected deficient immune response due to reduced values of IgA observed and, goes through further diagnostic evaluation at the Polyclinic for Laboratory Medicine, Department of Immunology and Department of Microbiology, as well as the Clinic of Radiology. In the period of year 2013, there were a total of 91 patients with reduced values of IgA, age up to 13 years, of which 55 boys and 36 girls. Results: Our study followed 91 patients, for the year 2013, through their medical charts and made evaluation of diagnostic and screening tests. The significance of this paper is to draw attention to the importance of diagnostic approach to IgA deficient pediatric patient and relevance of knowledge of individual diagnostic methods as well as to the proper interpretation of the results thereof.

Introduction: The finding of reduced value of immunoglobulin A (IgA) in children is frequent in daily medical practice. It is important to correctly interpret the findings as adequate further diagnostic evaluation of the patient in order to make the determination on the significance of such findings. In children younger than 4 years always consider the transient impairment of immunoglobulins, maturation of child and his immune system can lead to an improvement in the clinical picture. In older children decreased IgA may lead to serious illnesses that need to be recognize and acknowledge through the appropriate diagnostic methods. At the University Clinical Center Tuzla, children with suspected deficient immune response due to reduced values of IgA, goes through further diagnostic evaluation at the Polyclinic for Laboratory Medicine, Department of Immunology and Department of Microbiology, as well as the Clinic of Radiology. Material and methods: Our study followed 91 patients, for the year 2013, through their medical charts and made evaluation of diagnostic and screening tests. Conclusion: The significance of this paper is to draw attention to the importance of diagnostic approach to IgA deficient pediatric patient and relevance of knowledge of individual diagnostic methods as well as to the proper interpretation of the results thereof.