The objective of this paper was to present basic clinical characteristics and outcomes of treating Covid 19 patients during the second wave of the pandemic. In the retrospective study for the period from September 2020 to February 2021 it was analyzed disease history data and radiological lung changes, time from the initial start of the disease until hospitalization, parameters of blood gas analysis, comorbidities, and the outcome. The research covered 409 patients, out of which 263 (64.3%) were males. Average age was 67.07± 12.44 years (min. 20; max. 93). A high comorbidities prevalence (82.9%) was noticed out of which arterial hypertension (69.2%), diabetes mellitus (37.7%) and obesity (24.7%). On the radiological lung scan the most noticed changes were consolidation (46.2%), “ground glass” (41.3%) and interstitial changes (13%). Bilateral lung infiltration was noticed in 91.9% of the patients. Average oxygen saturation was 84.29%±10.28% (min. 35; max. 98; med. 87%). In patients with unilateral lung infiltration, average oxygen saturation was 85.09%±8.60% (med. 89%, min.61% max 98%), while in patients with bilateral lung infiltration average was 84.22%±10.42% (med. 87%, min. 35%, max. 98%). From the total all patients’ death was noticed in 35.7% cases. Morbidity of patients with unilateral lung infiltration was 27.3% and in patients with unilateral infiltration 36.4%. Hospital admission in the first week of the disease indicates the severity of the clinical condition and can be a predictor of poor outcome. Bilateral pulmonary infiltration, obesity and diabetes mellitus are risk factors for high mortality.

Background: Covid-19 primarily manifests itself as a respiratory disease, but also with numerous extrapulmonary symptoms and complications. The clinical form of the disease before hospitalization, has a great influence on the further course and occurrence of complications of the disease. Objective: To analyze the clinical and laboratory characteristics of patients with moderate and severe clinical form of the disease, the complications that developed in these patients during hospitalization and the outcome of the disease. Methods: The retrospective study included 520 patients from the Tuzla Canton, treated in the COVID-19 Hospital at University Clinical Center Tuzla in the period from March 27 to October 1, 2020. The source of data were the medical records of hospitalized patients. The clinical and laboratory characteristics of patients with moderate and severe clinical form of the disease and the complications that developed in these patients during hospitalization were analyzed. Results: The number of hospitalized men was statistically significantly higher, p=0.000. Most patients were in the age group of 60-69 years: 152 (29.3%), then in the age group of 50-59 years: 119 (22.9%). Women <70 years had more often a moderate, and women >70 years more often a severe clinical form of the disease, p<0.01. Patients with hypertension, diabetes mellitus, chronic lung diseases, cardiovascular diseases, hematological diseases and tumors of solid organs, with leukopenia and lymphopenia, elevated LDH, CRP, transaminases and serum ferritin, significantly more often had a clinically severe form of the disease (p<0.01). Patients with a severe clinical form of the disease on admission to the hospital had more frequent complications and death as outcome (p<0.01). Conclusion: Patients who were hospitalized with a severe form of COVID-19 had significantly more frequent disease complications and death as outcome.

Aim To evaluate clinical and epidemiological characteristics and outcome of patients with COVID-19, and impact of vaccine against COVID-19 on them. Methods This retrospective study included 225 patients treated from COVID-19 in the period from 1 to 30 September 2021 at the Clinic for Infectious Diseases, University Clinical Centre Tuzla (UCC Tuzla). For the diagnosis confirmation of Covid-19, RTPCR was used. Patients were divided in two groups: fully vaccinated with two doses of vaccine, and non-vaccinated or partially vaccinated. Results Of 225 patients, 120 (53.3%) were females, and 105 (46.7%) males. Mean age was 65.6 years. There were 26 (11.6%) fully vaccinated patients. Most common symptoms in unvaccinated patients were fatigue (70.9%), cough (70.4%) and fever (69.8%), and in vaccinated fever (76.9%), fatigue (69.2%) and cough (46.2%). Cough was more common in unvaccinated patients (p=0.013). Fatal outcome happened in 84 (37.3%) patients. Transfer to the Intensive Care Unit (ICU) and older age had a higher risk of death (p<0.001). Older age patients were more likely to have comorbidities like atrial fibrillation (p=0.017), hypertension (p<001) and diabetes mellitus (p=0.002). Atrial fibrillation (p<0.001), hypertension (p<0.001), diabetes mellitus (p=0.009) and history of stroke (p=0.026), were related to fatal outcome in unvaccinated patients, also did a shorter duration of illness prior to hospitalization (p<0.001) and shorter length of hospitalization (p=0.002). Conclusion Older patients with comorbidities, as well as those who were not vaccinated against COVID-19, were at higher risk for severe form of the disease and poor outcome.

Objectives: To avoid hospital spread of Coronavirus-2019 (COVID-19) and to analyze out of hospital outcomes after amputation. Methods: Prospective analysis of data obtained from 60 diabetic patients in 2020 was performed at Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina. Personal protection equipment included double surgical mask, glasses, disposable surgical coats, and surgical masks for patients. Swabs were used to take samples from wounds. We randomly divided patients in 2 groups of 30 patients each. In pre-operative treatment, we used local anesthesia lidocaine hydrochloride 2% (Belupo, Koprivnica, Croatia) in group A and systemic analgesia intravenous tramadol chloride 100 mg intravenous (Krka, Novo Mesto, Slovenia) in group B. Wounds were surgically treated each day and heal spontaneously. Periodical control exams were performed. Results: Wound healing did not present any statistically significant differences between groups (group A: 69±21.97 and B: 61±22.13 days, t=−1.22; p=0.11). No statistically significant differences (p<0.05) between groups A and B in wound healing regarding to gender or cigarette use was noted. Conclusion: No significant differences in amputation treatment between the 2 comparative groups were noted. No confirmed COVID-19 infections in medical staff who performed surgical interventions or in treated patients were detected.

Background Since the beginning of the COVID-19 pandemic, several inflammatory markers have been investigated as possible predictors of survival. Ferritin and from recently LDH have emerged as a possible marker that could serve to this purpose, with different cut-off levels than standard. Furthermore, serum elevations of these markers were reported in other viral infections such as dengue fever; while it has not been reported in MERS and SARS outbreaks and possibly making a biochemical distinction between COVID-19 and other similar diseases. The aim of this research was to establish independent admission levels of ferritin and LDH that predict lethal outcome more accurately. Methods In this prospective cohort study all the patients were hospitalized at UKC, B&H (n=137), between 28th of March and 1st of August 2020. The criteria for hospitalization was based on MEWS score, and all the inflammatory markers were evaluated in the first 72 hours of admission. Cut-off values of serum ferritin levels were set at 1500 ng/mL and LDH 350 U/L. Results Patients with serum ferritin levels >1500 ng/mL had 7.304 OR (CI95% 1.956-27.277; p=0.003) higher for lethal outcome than the group with <1500 ng/mL. Also, patients with levels of LDH >350 U/I had 5.560 (CI95% 2.480-12.468; p<0.001) higher OR of lethal outcome than patients with LDH <350 U/L. With the significant statistical difference between group means for both ferritin and LDH (p<0.001).Discussion Serum levels of ferritin >1500 ng/ml and LDH >350 U/L increase OR of lethal outcome. The levels of these inflammatory markers indicate the degree of inflammatory response and severity of the disaese as well as the possible outcome of the disease. Together these two markers could be used as predictors in clinical settings and treatment planning of patients with COVID-19.Conclusion: Together these two markers could be used as predictors in clinical settings and treatment planning of patients with COVID-19.

It is very important to make the smallest possible surgical paraumbilical transperitoneal incision, the so-called minilaparotomy 8-10 cm long, which is generally sufficient to perform surgery, and significantly reduces pain after surgery, significantly accelerates wound healing, and reduces the risk of postoperative hernia to a minimum [1]. If necessary, the surgical incision can always be further expanded.

A 11-years old female with growth problem and chronic renal failure was admitted for arteriovenous fistula (AVF) formation for long-term haemodialysis in the pediatric ward. During her hospital stay, continue to have a cuffed central venous catheter (CVC) as the first choice for vascular access. AVF the cubital artery vena cephalica was performed with a standard end-to-side anastomosis with a continuous running 8-0 prolene monofilament suture. The patient was discharged on the second post operative day, subsequent to a normal AVF primary patency. We recommend that vascular and pediatric Hemodialysis centers establish a strategy supporting AVF creation in small children when peritoneal dialysis is contraindicated and pre-emptive kidney transplantation is not feasible. *Correspondence to: Dragan Piljic, M.D., Ph.D., Department of Cardiovascular Surgery, University Clinical Center Tuzla, Bosnia & Herzegovina, Tel: +38735303202; E-mail: dragan.piljic@dr.com

BACKGROUND Isolated iliac artery aneurysms are rare and occur predominantly in men at an older age. Such aneurysms can rupture into an adjacent organ (such as the bowel, bladder or ureter) or into the adjacent common iliac vein, resulting in an arteriovenous fistula. INTRODUCTION Formation of an internal iliac arteriovenous fistula caused by spontaneous rupture of an atherosclerotic iliac artery aneurysm wall is an exceedingly rare yet serious complication. Methods / Results: This article presents a case of an internal iliac arteriovenous fistula caused by rupture of an atherosclerotic giant iliac artery aneurysm. CONCLUSION Rapid diagnosis and meticulous surgical technique improve outcomes in patients with this rare vascular complication.

INTRODUCTION This survey aims to assess knowledge, attitude and stigma towards HIV patients, among medical students in Tuzla, Bosnia and Herzegovina. We also aimed to assess potential risk factors for HIV infection among fourth year medical students. METHODOLOGY Data were collected from specific questionnaire that was completed by 171 students of the Faculty of Medicine, University of Tuzla. A multivariable logistic regression was performed. RESULTS Majority of students (79%) had a good knowledge of HIV, (median value of correct answers was 9 (95%) with at least 6 correct responses). Also, majority of students (73.6%) had a positive attitude towards HIV patients and the median positive value was 6 (95% CI: 6-7). More than a third of students considered that all hospitalized patients should be tested for HIV. Total of 81% of students considered that they should inform the sexual partner of HIV positive patient, although she/he disagrees. 61.4% of students had a discriminatory attitude towards HIV, with the median values of 3 (95% CI: 3-3). Multivariate regression analysis identified positive attitude towards HIV patients as an independent predictor for a non-discriminatory attitude. Moreover, an overall attitude towards HIV patients defines student`s determination to work with AIDS population. Male gender, and older age, were identified as predictors of risky behavior. CONCLUSIONS Preventive measures, including better HIV education, are crucial. Knowledge can increase awareness of HIV infection, decrease the incidence and reduce stigma towards HIV patients.