<p><strong>Introduction. </strong>Antibiotic resistance is a major threat to public health globally. The aim was to examine the impact of the COVID-19 pandemic on the distribution and antimicrobial resistance of pathogenic microorganisms isolated from samples&nbsp;<br />obtained during standard hospital care in one hospital center. &nbsp;<br /><strong>Methods.</strong> Data were obtained retrospectively from a database of the hospital microbiology laboratory. Study sample consisted of 3012 samples tested before the pandemic in 2019 and 3130 samples from the pandemic period in 2021.&nbsp;<br /><strong>Results.</strong> There was no statistically significant difference in the occurrence of agents that were resistant to all antibiotics between the observed years, but there was the difference in the occurrence of those agents between departments, with the highest frequency in the intensive care unit and the COVID-19 department (p&lt;0.001). Isolation of Acinetobacter bacteria increased 2.7 times, and Clostridioides difficile 6.4 times during 2021 compared to 2019. Statistically significant differences were registered in resistance to: imipenem, piperacillin-tazobactam, ceftayidime, cefepime, glycopeptides, aminoglycosides, levofloxacin and ciprofloxacin in 2021 compared to 2019.&nbsp;<br /><strong>Conclusion. </strong>Our results suggest possible influence of COVID-19 on antimicrobial resistance and input a need for a new larger study addressing this issue.</p>

In contrast to electromagnetic fields, static magnetic fields (SMFs) have not been extensively studied in terms of their potential health consequences. Although upward- and downward-oriented magnetic poles may cause various biological effects, only the pole with the upward orientation has been mainly investigated. Considering that the interaction of antigen-presenting cells (APCs) and T lymphocytes is crucial to trigger an immune response, we assessed the effect of long-term exposure of human T lymphocytes and dendritic cells (DCs) to moderate strength SMFs of different orientations focusing on the cytokine profile of activated T cells. Cultures of allogenic T lymphocytes and DCs (immature and matured by TLR3 and TLR7 agonists) were continuously exposed to four SMFs. The intensity of the applied field was 1 militesla (mT) or 56 mT of the upward- and downward-oriented pole of the SMF. Cell culture supernatants were assayed for IFN-γ, IL-4, IL-17, TNF-α, TNF-β, IL-1 β, IL-6, IL-8, and IL-10 by ELISA or flow cytometry. The upward-oriented 56 mT SMF significantly increased the release of IFN-γ and TNF-β (both p < 0.05) in the cell culture supernatants of T cells and immature DCs. In contrast, the same cultures exposed to the upward-oriented 1 mT SMF showed significantly elevated levels of IL-17 (p < 0.05). The levels of IL-4, TNF-α, IL-1 β, IL-6, IL-8, and IL-10 were not affected by the upward-oriented SMF. The downward-oriented 56 mT SMF increased TNF-α release when T cells were stimulated with mature DCs. The production of other cytokines was unchanged by the downward-oriented SMF. These findings demonstrate for the first time different in vitro biological effects of upward- and downward-oriented static magnetic fields on the cytokine production of T cells activated by DCs, helping to better understand SMF effects on the immune system and suggesting that the selective SMF effect on the immune response could have potential therapeutic effects in different immune-mediated disorders.

Background: Severe coagulation abnormalities are common in patients with COVID-19 infection. We aimed to investigate the relationship between pro-inflammatory cytokines and coagulation parameters concerning socio-demographic, clinical, and laboratory characteristics. Methods: Our study included patients hospitalized during the second wave of COVID-19 in the Republic of Serbia. We collected socio-demographic, clinical, and blood-sample data for all patients. Cytokine levels were measured using flow cytometry. Results: We analyzed data from 113 COVID-19 patients with an average age of 58.15 years, of whom 79 (69.9%) were male. Longer duration of COVID-19 symptoms before hospitalization (B = 69.672; p = 0.002) and use of meropenem (B = 1237.220; p = 0.014) were predictive of higher D-dimer values. Among cytokines, higher IL-5 values significantly predicted higher INR values (B = 0.152; p = 0.040) and longer prothrombin times (B = 0.412; p = 0.043), and higher IL-6 (B = 0.137; p = 0.003) predicted longer prothrombin times. Lower IL-17F concentrations at admission (B = 0.024; p = 0.050) were predictive of higher INR values, and lower IFN-γ values (B = −0.306; p = 0.017) were predictive of higher aPTT values. Conclusions: Our findings indicate a significant correlation between pro-inflammatory cytokines and coagulation-related parameters. Factors such as the patient’s level of education, gender, oxygen-therapy use, symptom duration before hospitalization, meropenem use, and serum concentrations of IL-5, IL-6, IL-17F, and IFN-γ were associated with worse coagulation-related parameters.

Background : Abnormal uterine bleeding (AUB) is one of the most common health problems encountered in women of the peri-menopausal age group. The aim of this study was to investigate the characteristics of functional AUB in perimenopausal women, and to identify predictors of the occurrence of functional AUB in perimenopausal women. Methods : This was a cross-sectional study that included 45 women with complaints of AUB admitted to the gynecology ward in the University Hospital in Foča, and 45 women without AUB who underwent a gynecological examination in the Primary Health Center in Foča, Bosnia and Herzegovina. We included women with AUB who had a normal ultrasound finding without obvious genital or cervical lesions, and who were not on hormonal therapy. The existence of AUB was determined on the basis of a clinical examination by a gynecologist and existing medical documentation. A logistic regression model was used to assess the possible relationship between the occurrence of the functional AUB and the risk factors for its occurrence. Results : The mean patient age was 48.38 ± 2.40 years. There was no significant difference in age, frequency of physical activity, or previous use of oral contraceptives between the two groups of patients divided by the presence of the functional AUB in perimenopause. The logistic regression model showed that age ( p = 0.008), high values of body mass index (BMI) ( p = 0.001), consumption of alcohol and cigarettes on a daily basis ( p = 0.001), and hypertension ( p = 0.046) represented significant risk factors associated with functional AUB in perimenopausal women. Conclusions : During routine exams of women approaching menopause, gynecolo-gists should emphasize the harms of smoking and alcohol use, as well as the significance of non-pharmacological and pharmacological methods for the treatment of obesity and hypertension.

<p>Diabetic retinopathy (DR) is a chronic microvascular complication of diabetes. Due to the dramatic increase in the number of diabetes cases, the prevalence of DR has also risen, making it the leading cause of blindness among the working-age population worldwide, despite the availability of screenings and modern therapeutic options. Risk factors for the development and progression of DR (duration of diabetes, hypertension, hyperglycemia, dyslipidemia, and genetic factors) have been investigated in numerous epidemiological studies and clinical researches, but the research results were not consistent. In recent years, there has been considerable interest in the study of dyslipidemia in diabetes as one of the factors that could influence the onset and progression of DR, as well as apolipoproteins as potentially better biomarkers for DR. The results of our research also point in that direction. Identifying the risk factors for DR is crucial for enabling adequate prevention and raising awareness among individuals with diabetes about the importance of taking appropriate measures to prevent this microvascular complication.</p>

The constant worsening of antimicrobial resistance (AMR) imposes the need for an urgent response. Use of antibiotics (AB), both due to irrational prescribing by doctors and irrational use by patients, is recognized as one of the leading causes of this problem. This study aimed to identify knowledge, attitudes, and practices about AB use and AMR within the general population, stratified by age, gender, and urban/rural areas during the COVID-19 pandemic. This questionnaire-based cross-sectional study was conducted in April 2022 among patients who visited three health centers in the eastern region of Bosnia and Herzegovina. A high frequency of AB use was observed during the COVID-19 pandemic (64.2% of respondents were treated with AB). Age and place of residence have not been shown to be factors associated with AB use practices that pose a risk for AMR. However, female gender (β = 0.063; p = 0.041), better knowledge (β = 0.226; p < 0.001), and positive attitudes (β = 0.170; p < 0.001) about use of AB and towards to AMR proved to be factors associated with better practice by respondents. Women, younger respondents, and respondents from urban areas showed better knowledge, attitudes, and behavior about the use of AB and AMR during the COVID-19 pandemic.

Introduction. Acute appendicitis is the most common cause of the acute abdomen. Based on the idea that appendicitis is a progressive disease eventually leading to perforation, removal of the appendix is the gold standard of treatment. Material and Methods. The objective of the study is to determine if there is any difference in the occurrence of postoperative complications, and if hospitalization differs depending on the appendicitis surgery method used with the patients. A retrospective analysis was made using the data from the hospital sample of patients admitted to the University Hospital in Foca in the period from January 2019 to December 2021. Results. In the period that was retrospectively analyzed, 107 patients diagnosed with acute appendicitis were operated on. There was no statistically significant difference between the treated groups in relation to the degree of appendicitis, type and duration of symptoms, diagnostic procedures and the time that had elapsed from admission to surgery. The Alverado Score in the probable appendicitis group was 41.1%. The most common symptoms were palpation sensitivity in the inguinal region (84.1%), and pain in the right lower quadrant (69.1%), intraoperative findings of uncomplicated appendicitis 58%, and 25.2% intraoperative findings inconsistent with the pathohistological ones. Conclusion. Acute appendicitis is one of the most common emergency surgical conditions, which requires surgical intervention if not treated in time, and causes life-threatening consequences. Surgical treatment with selected techniques for faster establishment of the gastrointestinal tract function, shorter stay in the hospital, faster recovery and return to daily activities.

Complications in colorectal surgery carry a high risk of morbidity and mortality, prolong hospitalization time and increase treatment costs, and the largest number of postoperative complications is related to surgical site infection (SSI). Antibiotic prophylaxis started in the fifties of the last century and changed with each new antibiotic. The following were used in order: aminoglycosides (1943), macrolides (1952), polymyxins (1958), and cephalosporins (1965). With the discovery of metronidazole in 1970, the prophylactic spectrum was extended to include anaerobic bacteria, which are an indispensable part of the flora in this anatomical region. Due to the nature of the gastrointestinal tract, it was believed that oral antibiotic prophylaxis and mechanical bowel preparation (MBP) could achieve intestinal sterilization and thus ensure a safe surgical intervention. However, studies have shown that MBP did not have an overall beneficial effect on postoperative complications and caused significant patient discomfort, so it was almost abandoned. Today, it is known that about 16% of surgical infections are caused by multiresistant bacteria, and only oral antibiotic prophylaxis is not sufficient to prevent these infections. Namely, in the race between bacterial resistance and the development of new antibiotics, antibiotics are increasingly lagging, and the treatment of complications remains a nightmare for surgeons. For this reason, the prevention of SSI in colorectal surgery is a challenge for 21st-century medicine. In modern surgery, both open and laparoscopic, the first and second generations of intravenous cephalosporins are most often used for prophylactic purposes, as antibiotics of a sufficiently broad spectrum, with favorable pharmacokinetics and rare side effects. New research indicates that in colorectal surgery, the combination of standard intravenous prophylaxis with the addition of an oral antimicrobial the day before surgery is superior when it comes to SSI prevention. However, there are still no clear recommendations on the regimen and type of antibiotics and they should be given in institutional guides and protocols, taking into account the bacterial spectrum in the local environment, as well as resistance, and the availability of appropriate drugs. Therapeutic use of antibiotics is reserved for acute conditions in colorectal surgery and its complications. For therapeutic purposes, more potent antibiotics are used against the expected pathogens, usually a combination of several antibiotics, such as third or fourth-generation cephalosporins, metronidazole, fluoroquinolones, or piperacillin/tazobactam and others. When it comes to the therapeutic use of antibiotics in colorectal surgery, research indicates that the most important thing is to recognize the infection in time and immediately start treatment, correct the therapy according to the causative agent, and also to stop the administration of antibiotics in time, to avoid unwanted complications and already advanced bacterial resistance.

Abstract Surgical treatment and formation of a stoma can be lifesaving for colorectal cancer patients. However, the quality of life is often impaired in patients with stoma. The goal of this study is to determine the quality of life of patients with stoma and cancer, and the relationship between the quality of life and characteristics of these patients. The study was conducted from 2018 to 2020 and included a total of 64 patients of both sexes with colorectal cancer and temporary or permanent stoma. The European Organization for Research and Treatment of Cancer with Quality of Life Questionnaire (EORTC QLQC29-30) and the anonymous WHO Quality of Life Questionnaire SF-36 were used for self-assessment of quality of life. Our study included 39 (61.0%) men and 25 (39.0%) women. 24 patients (37.5%) had colostomy, 14 patients (21.9%) had ileostomy, and 26 patients (40.6%) underwent surgery for resection of colorectal cancer without stoma. A significant number of women were in the group of patients with a permanent stoma (p = 0.01). There was no statistically significant difference in the assessment of general health (p = 0.680) and quality of life (p = 0.721) during the past month in relation to gender. Patients without a stoma rated their general health better compared to those with stoma and the difference reached statistical significance (p = 0.035). There was no statistically significant difference in the assessment of quality of life between the group of patients with stoma and without stoma, as well as between the patients of different age groups. Patients with stoma rated their general health as worse, but not their quality of life.

The pandemic of COVID-19 has brought many changes in health care systems at all levels of health care. The increase in the number of cases of COVID-19 has led to overuse and misuse of antibiotics.The aim of this study was to compare the consumption of antibiotics for systemic use in outpatients in the Republic of Srpska (RS), before and during the first year of the COVID-19 pandemic, as well as the association between antibiotic consumption and the rate of incidence and mortality of COVID-19. The total consumption of the antibiotics for systemic use (J01) in outpatients in the Republic of Srpska during 2019 was 19.40 DDD/TID, with an increase to 30.80 DDD/TID in 2020.Significantly higher use of penicillin (10.58 ± 11.01 DDD/TID in 2019 vs. 17.10 ± 13.63 DDD/TID in 2020), cephalosporins (2.68 ± 1.90 DDD/TID in 2019 vs. 5.93 ± 2.77 DDD/TID in 2020) and macrolides (2.14 ± 2.22 DDD/TID in 2019 vs. 3.40 ± 3.44 DDD/TID in 2020) was observed during the pandemic period. It is necessary to improve the prescribing practice of antibiotics at the primary health care level, public awareness about rational use of antibiotics, as well as the current antibiotic stewardship programs and control their implementation.

Speech is a way of communication formed by rhythmic units of syllables, words and sentences, and as such is inherent in man, the only being whose organs and psyche are trained for this process. Delayed speech is defined as a phenomenon in which a child does not start speaking on time, or there are errors in the speech pattern that are not appropriate in relation to a given age. It is known that significant risk factors for the development of delayed speech in preschool children are physical, and most often social and emotional in nature. For the normal development of speech, it is necessary that the child is in a human environment, and therefore the circle of people with whom children come into contact should always be expanded. The aim of this study is to review the existing literature on studies examining the impact of social isolation during the COVID-19 pandemic on preschool children, as well as the speech and language development in preschool children. The recent pandemic of corona virus infection (COVID-19) has led to a state of emergency, quarantine, closure of public institutions, and preschools, kindergartens and schools in 172 countries. These epidemiological measures have led to social isolation and the need for children to learn from home, which has manifested itself in the emergence of difficulties in the development of speech and language. Research has shown that during the pandemic, children spent significantly more time watching television and computer screens than before pandemic, and less in play and physical activity.

The vascular approach is a prerequisite for performing hemodialysis, but their "weak points" are different and frequent complications. Modern guidelines recommend native arteriovenous fistula (AVF) as the first choice of vascular approach because it is characterized by the longest survival and the least complications compared to other vascular approaches. All complications of AVF can be divided into intraoperative, early, and late postoperative. This paper presents the late postoperative complications of AVF, their frequency, causes, diagnosis and treatment. The most important late postoperative complications are: stenosis, thrombosis, aneurysm or pseudoaneurysm formation, infection, hand edema, hematoma, ischemic steal syndrome, ischemic neuropathy, congestive heart failure. Large differences in the frequency of each complication in earlier studies can be explained by differences in surgical technique, localization of AVF, diagnostic methods, but, above all, differences between the presented groups of patients. It is described that the age of patients, sex, underlying disease, the presence of comorbid conditions and various metabolic and immune disorders characteristic of chronic renal failure, as well as the way of using and caring for AVF significantly affect the occurrence of AVF complications. One of the main predictors of AVF success and survival is the quality of the patients' blood vessels, and therefore careful examination of blood vessels before approaching AVF creation is of particular importance. The creation, use and care of AVF is the task of the team of health professionals who take part in the treatment of these patients, and successful treatment requires their good cooperation, as well as cooperation with patients.

Paraovarian cysts originate from the mesothelium and are presumed to be remnants of M?llerian or Wolffian ducts. In majority of cases they are found to be 10-80 mm in diameter and do not cause any symptoms. Paraovarian cysts can be found unexpectedly during an operation or on ultrasound examination performed for other reasons. They are most freequently discovered on ultrasound examination. However, due to the proximity of the ovary for which cystic formations are not rare, the diagnosis of these lesions can be a challenge. They are mostly asymptomatic and only large lesions (?20 cm in diameter) become symptomatic. Although these are mostly benign tumors, in rare cases they can become borderline or true malignancies. Most paraovarian cysts are found in the third and fourth decade of life. Paraovarian cyst complications include: compression of the surrounding structures of the pelvis minor and abdomen, pelvic pain, cyst torsion and rupture. Except for the already mensioned complications available literature has so far failed to show cases of uterine prolapse caused by an increase of intra-abdominal pressure due to the expansive growth of giant paraovarian cystic formation.

The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards (MTB) from health-care institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization, and optimization of the procedures for the diagnosis, treatment, and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a MTB comprised of at least: A medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.