Background Because of the COVID-19 pandemic, people were recommended to implement new health behaviors into their daily routines to prevent the viral spread. The aim of this study was to investigate whether specific health behaviors, such as wearing face masks, taking immunity boosters and visiting risky places were associated with a higher level of stress due to COVID-19 in the general adult population. Method This cross-sectional study was conducted from September 1, 2020 to October 1, 2021 in eight randomly chosen cities of two Serbian speaking countries (Republic of Serbia and Republic of Srpska - Bosnia and Herzegovina). Participants filled a socio-epidemiologic questionnaire, COVID Stress Scales (CSS) and the Perceived Stress Scale (PSS). Results The study included 2,301 participants with an average age of 36.72 ± 13.82 years of whom 54.9% were female (p = 0.001). Most participants were healthy, highly educated, employed, married, non-smokers and consumed alcohol. The mean total CSS score was 32.7 ± 23.8 out of 144, suggesting a relatively low stress due to COVID-19. The mean PSS was 19.43 ± 5.05 out of 40 indicating slightly increased level of general stress. Participants who reported higher CSS scores were more likely to wear face masks, use immunity boosters, go to cafes and clubs, have chronic illnesses, have suspicious, but not proven contact with COVID-19 positive people, and use multiple sources of information about COVID-19. Conclusion Few participants experienced high levels of stress due to COVID-19. People who used face masks, immunity boosters and visited risky places reported a higher level of stress during the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s41043-025-00833-2.

Tungsten disulfide (WS2) nanoparticles have emerged in the biomedical field as potential theranostic agents due to their unique properties, including biocompatibility. However, their impact on the immune response remains unexplored. This study aimed to evaluate the effects of inorganic fullerene-like WS2 (IF-WS2) nanostructures on human peripheral blood mononuclear cells (PBMCs) in vitro. The study investigated several parameters to evaluate the effects of IF-WS2 nanoparticles. Cytotoxicity was assessed by measuring cell viability, apoptosis, and necrosis. Internalization of IF-WS2 by PBMCs was analyzed using morphological and flow cytometric techniques. Proliferation was studied in CellTrace Far Red-prestained total PBMCs stimulated with phytohemagglutinin (PHA) and in isolated T cell cultures stimulated with CD3/CD28-coated beads. Additionally, the production of cytokines and chemokines was measured in culture supernatants of total PBMCs and T cells. IF-WS2 nanoparticles were non-cytotoxic up to a concentration of 200 µg/mL. Concentrations ≥25 µg/mL inhibited PHA-stimulated PBMC proliferation but did not affect T cell proliferation. Morphological and flow cytometric analysis demonstrated dose- and time-dependent internalization of IF-WS2 by macrophages. Additionally, IF-WS2 significantly reduced the production of pro-inflammatory cytokines (IL-1β, TNF-α, IL-8, MCP-1, and GRO-α) in PHA-stimulated PBMCs. Th1, Th17, and Th21 cytokines were downregulated, while Th2, Th9, and T regulatory cytokines were upregulated. In conclusion, this study demonstrated for the first time that pristine IF-WS2 nanoparticles, at non-cytotoxic concentrations, exhibit notable anti-inflammatory and immunomodulatory properties on activated PBMCs in vitro.

ABSTRACT Introduction The aim of the study was to assess the seroprevalence of SARS‐CoV‐2 in the Republika Srpska, Bosnia and Herzegovina, after five waves of COVID‐19 and 1 year after introduction of vaccination to better understand the true extent of the COVID‐19 pandemic in the population of the Republika Srpska and role of vaccination in achieving herd immunity. Methods The population‐based study was conducted from December 2021 to February 2022 in a group of 4463 individuals in the Republika Srpska. Total anti–SARS‐CoV‐2 antibodies were determined in serum specimens using the Wantai total antibody ELISA assay. Quantitative analysis, using Kantaro IgG assays, was performed in subsamples (1273 specimens) to asses and compare levels of IgG among vaccinated, recovered and participants with hybrid immunity. To adjust for age and gender distribution in sample, poststratification method is applied. Results The overall cumulative seroprevalence was 94.6% (95% CI = 93.9–95.3). Significantly higher seroprevalence rates were observed among vaccinated 97.8% (95% CI = 97.3–98.4) comparing to unvaccinated participants (89.5%, 95% CI = 88.0–91.0). Seroprevalence increases with the number of received doses. Among various professions, the highest seroprevalence was found in the service industry (98.1%), education (98.0%) and healthcare (96.9%). We found that 2.2% of vaccinated and 3.6% of participants with SARS‐CoV‐2 positivity during 2021 had no detectable IgG antibodies. Both seroprevalence (98.6%) and antibody titres (1094.4 AU/mL) were significantly higher among people with hybrid immunity. Conclusion Our findings reveal a 2.3‐fold increase in seroprevalence of SARS‐CoV‐2 antibodies due to infection and vaccination, comparing to the first study performed 1 year earlier. This study provides better understanding of the SARS‐CoV‐2 transmission and highlights the important role of the vaccination in achieving the population immunity. Periodically conducted population‐based seroprevalence studies are important to understand temporal trends and assess surveillance system performance and public compliance with vaccination policies.

Introduction Alcoholic liver disease represents a growing global pandemic, particularly among younger men, and is one of the leading causes of premature death worldwide. Observing complications during the decompensation stage and monitoring disease progression dynamics using scoring systems are particularly important. Materials and methods This retrospective-prospective, descriptive, and analytical study included 123 male patients with a confirmed diagnosis of alcoholic liver cirrhosis, hospitalized at the Internal Medicine Clinic, University Clinical Centre of the Republic of Srpska in Banja Luka, Department of Gastroenterology and Hepatology. The study period spanned from January 2023 to January 2025, with the note that patient selection and monitoring began much earlier, in June 2021. After hospitalization, patients were followed monthly through a program of outpatient control examinations, with disease outcomes recorded. The study included all male patients over 18 years of age with a confirmed diagnosis of alcoholic liver cirrhosis and signed informed consent. Female patients and those with cirrhosis or other etiologies were excluded. For statistical data analysis, the Statistical Package for the Social Sciences (SPSS) version 29 (IBM Corp., Armonk, NY, USA) was used. The statistical analyses performed included median, standard deviation, analysis of variance, Student's t-test, chi-square test, and survival analysis. Results The mean age of the patients was 59.09±9.316 years. Most of them had anemia: 113 patients (91.86%) with decreased erythrocytes and 109 patients (88.62%) with decreased hemoglobin. Thrombocytopenia was observed in 104 patients (84.55%), while an increased mean corpuscular volume (MCV) was recorded in 68 patients (55.28%). Among biochemical parameters, the most common findings were increased bilirubin in 98 patients (79.67%), aspartate aminotransferase (AST) in 111 patients (90.24%), gamma-glutamyl transferase (GGT) in 109 patients (88.61%), and D-dimer in 110 patients (89.44%), while albumin levels were decreased in 107 patients (87.00%). Hyponatremia (decreased sodium) was observed in 63 patients (51.21%), and hypercalcemia (increased calcium) in 116 patients (94.30%). Jaundice was the most common external sign, present in 98 patients (79.67%), while ascites were noted in 86 patients (69.91%). Death during the first decompensation occurred in 31 patients (25.20%), of whom 17 (54.83%) died in the hospital. The leading cause of mortality is bleeding from esophageal varices. Conclusion Although a healthy liver performs over 200 distinct functions in the human body, a cirrhotic liver leads, one might say, to an even greater number of dysfunctions. This pathology is extremely complex, characterized by numerous complications and high treatment costs, which, despite all applied measures, do not ensure a favorable long-term prognosis without liver transplantation.

Background/Aim. Piclidenoson (CF101, IB-MECA), a selective agonist of the A3 adenosine receptor (A3AR), is used in clinical trials for the treatment of psoriasis. Emerging data from in vitro and in vivo studies suggest that piclidenoson possesses anti-inflammatory and immunomodulatory properties, but its action on human peripheral blood mononuclear cells (PBMCs) remains unknown. The aim of this study was to examine the anti-inflammatory effects of piclidenoson in a model of phytohaemagglutinin (PHA)-stimulated human PBMCs culture. Methods. Human PBMCs were isolated from the venous blood of healthy donors (n = 4) and treated with different concentrations of piclidenoson. Flow cytometry and the 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) test were used to determine cell viability, while the MTT method and the carboxyfluorescein succinimidyl ester (CFSE) staining method were used to analyze the effect of picl idenoson on cell proliferation. Levels of tumor necrosis factor (TNF)-?, interleukin (IL)-6, IL-1?, IL-23, IL-36, IL-5, interferon (IFN)??, IL-17, and IL-10 were measured using a specific sandwich enzyme-linked immunosorbent assay (ELISA). Results. The results of cytotoxicity tests showed that the highest applied concentration of piclidenoson (1,500 nM) reduced the metabolic activity of PBMCs (p < 0.05) and increased the percentage of late apoptotic (p < 0.05) and necrotic cells (p < 0.01). Non-toxic concentrations (250, 500, and 1,000 nM) decreased the proliferation of PBMCs (p < 0.05) compared to the control cells. These concentrations also decreased the production of TNF-? (p < 0.001). Piclidenoson at concentrations of 250 and 1,000 nM reduced the production of IL-23 (p < 0.05) while the concentrations of 500 and 1,000 nM reduced the production of IL-36 (p < 0.05). Piclidenoson at 1,000 nM increased IL-1? production, while other concentrations decreased its production (p < 0.01). The highest concentration (1,000 nM) inhibited the production of IL-5 (p < 0.05) and IFN-? (p < 0.01) while all applied concentrations inhibited the production of IL-17 (p < 0.001). Furthermore, piclidenoson increased the production of IL-10 in all applied concentrations (p < 0.01). Conclusion. At non-toxic concentrations, piclidenoson exerts anti-inflammatory properties associated with the inhibition of proliferation and modulation of cytokine production in PHA-stimulated PBMCs culture.

Dapsone is a sulfone used in treating inflammatory skin conditions. Despite its widespread dermatological use, the pharmacological actions of dapsone remain poorly understood. Here, we examined how different aspects of neutrophil functions are affected by dapsone. Peripheral blood neutrophils from healthy donors were stimulated with phorbol-12-myristate-13-acetate (PMA), N-formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP), or calcium ionophore (CaI) or primed with cytokines prior to stimulation, in the presence of different concentrations of dapsone (from 10 to 50 µg/mL), followed by analyses of their survival, phenotype, and functional properties. We found that dapsone at the concentration of 50 μg/mL induced a significant neutrophil apoptotic rate during 6 h and 18 h, while other concentrations were well tolerated compared to control non-treated cells. However, dapsone significantly decreased the induced oxidative burst of neutrophils at all non-cytotoxic concentrations. Additionally, dapsone showed a dose-dependent suppression of NETosis in activated neutrophils. The production of IL-8 by dapsone-treated neutrophils was decreased under both stimulated (fMLP) and primed (TNF-α/fMLP) conditions. Moreover, dapsone inhibited the expression of CD11b/CD18, CD66, and CD89 and reversed or significantly mitigated the downregulation of CD16, CD32, CD181, CD88, and CD62L on neutrophils after priming and fMLP stimulation. In conclusion, our results indicate the complexity of dapsone actions on neutrophil functions, extending previous knowledge on the suppression of oxidative burst and IL-8 production upon neutrophils’ activation. Suppressed NETosis and modulation of marker expression associated with different neutrophil functions under inflammatory conditions are new findings, not recognized previously.

Background: The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic’s second year. Method: A cross-sectional study was conducted on a nationally representative sample (n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results: This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions: Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.

Introduction: An essential component of any profession is competent and confident staff. In palliative care, a wellrounded approach and versatile knowledge of staff and students are of great importance. Measuring these competencies is very important for the development of palliative care and health care. Methods: Measurement of competencies in palliative care by analyzing existing instruments and questions in palliative care. Process of developing a new instrument for measurement of competencies in palliative care PALCOM, using cross-sectional methodology with nurses from Bosnia and Herzegovina. Results: The results are presenting findings of research done with nurses from BIH using two main variables: Years of work experience and level of education of the participants. Main difference is between the two competencies: Pain assessment and management, education, and care for the patient’s family regarding the level of education. Conclusion: The need for measuring competencies is evident in the daily evolution of palliative care, community-based palliative care, hospice care, and subspecialized palliative care. There is no questionnaire that can measure all competencies, but the use of the general competencies in the PALCOM questionnaire can cover this area with the measurement of different domains and the competencies specific to these domains.

Background: Frequent episodes of nasal symptoms are the usual clinical manifestations (CM) of allergic rhinitis (AR) and have a significant negative impact on health-related quality of life (HRQoL) in adolescents. The purpose of this cross-sectional study was to test the hypothesis that cytokines in nasal mucus may be associated with HRQoL in adolescents with AR. Methods: European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), “The Adolescent Rhinoconjunctivitis Quality of Life Questionnaire” (AdolRQLQ) and the Total 4 Symptom Score (T4SS) scoring system were administered to 113 adolescents with AR, nonallergic rhinitis (NAR) and to healthy control subjects. Nasal secretions were sampled and tested for 13 cytokines using a multiplex flow cytometric bead assay. Results: The AR group had significantly lower EQ-5D-3L (0.661 ± 0.267 vs. 0.943 ± 0.088; p < 0.001) and higher AdolRQLQ total scores (2.76 ± 1.01 vs. 1.02 ± 0.10; p < 0.001) compared to the control group. The AR group had higher concentrations of IL-1β (p = 0.002), IL-6 (p = 0.031), IL-8 (p < 0.001), IL17-A (p = 0.013) and IL-18 (p = 0.014) compared to the control group, and IL-1β, IL-6, IL17-A and IL-18 were significantly (p < 0.050) increased with disease progression. Cytokines IL-1β, IL-6, as well as severe CM, were identified as significant predictors of lower HRQoL in adolescents with AR. Conclusions: This study identified IL-1β, IL-6, as well as severe CM, as predictors of lower HRQoL in adolescents with AR. However, these results should only serve as a starting point for additional confirmation research.

Introduction: Metacognition, which refers to the ability to oversee and regulate one's cognitive activities, plays a crucial role in medical education. Evaluating metacognitive awareness is particularly important for university students, as it impacts their learning strategies and academic performance. The objective of this study was to examine the psychometric characteristics of the Serbian adaptation of the Metacognitive Awareness Inventory (MAI), with an emphasis on its construct validity and internal consistency. Materials and methods: This was a cross-sectional study conducted at the Faculty of Medicine University of Belgrade, on third-year medical students during October 2024. The psychometric properties of the Serbian version of the MAI were evaluated by assessing its factorial structure and internal consistency. The MAI consists of 52 items, comprising two primary components: 'Knowledge of Cognition' and 'Regulation of Cognition'. The subcomponent of "knowledge of cognition" were categorized into declarative knowledge, procedural knowledge, and conditional knowledge, whereas "regulation of cognition" subcomponent were classified into planning, information management strategies, comprehension monitoring, debugging, and evaluation. Results: A total of 426 medical students were included in the study. The mean age of the respondents was 21.3 ± 1.4 years, and the majority were females (68.5%). The mean score of the scale was 199.0. The internal consistency analysis of the Serbian version of the MAI questionnaire yielded a Cronbach's a of 0.94, and a McDonald's o of 0.95 for the entire scale, which indicates excellent scale reliability. The Serbian version of the MAI questionnaire was validated using confirmatory factor analysis, supporting both the hypothesized eight-factor and two-factor structures. The eight-factor model showed good fit indices (IFI = 0.908, CFI = 0.905, RMSEA = 0.042), with statistically significant factor loadings (p < 0.05). Similarly, the two-factor model demonstrated adequate fit (IFI = 0.921, CFI = 0.918, RMSEA = 0.039), with all loadings also significant (p < 0.05). Conclusion: The present study revealed the Serbian version of MAI as reliable and valid tool for identifying medical students' metaconginive awareness.

Sitagliptin, an anti-diabetic drug, is a dipeptidyl peptidase (DPP)-4/CD26 inhibitor with additional anti-inflammatory and immunomodulatory properties. In this study, we investigated for the first time the effect of sitagliptin on the differentiation and functions of human dendritic cells generated from monocytes (MoDCs) for 4 days using the standard GM-CSF/IL-4 procedure. LPS/IFN-γ treatment for an additional 24 h was used for maturation induction of MoDCs. Sitagliptin was added at the highest non-cytotoxic concentration (500 µg/mL) either at the beginning (sita 0d protocol) or after MoDC differentiation (sita 4d protocol). Sitagliptin impaired differentiation and maturation of MoDCs as judged with the lower expression of CD40, CD83, CD86, NLRP3, and HLA-DR, retention of CD14 expression, and inhibited production of IL-β, IL-12p70, IL-23, and IL-27. In contrast, the expression of CD26, tolerogenic DC markers (ILT4 and IDO1), and production of immunoregulatory cytokines (IL-10 and TGF-β) were increased. Generally, the sita 0d protocol was more efficient. Sitagliptin-treated MoDCs were poorer allostimulators of T-cells in MoDC/T-cell co-culture and inhibited Th1 and Th17 but augmented Th2 and Treg responses. Tolerogenic properties of sitagliptin-treated MoDCs were additionally confirmed by an increased frequency of CD4+CD25+CD127- FoxP3+ Tregs and Tr1 cells (CD4+IL-10+FoxP3-) in MoDC/T-cell co-culture. The differentiation of IL-10+ and TGF-β+ Tregs depended on the sitagliptin protocol used. A Western blot analysis showed that sitagliptin inhibited p65 expression of NF-kB and p38MAPK during the maturation of MoDCs. In conclusion, sitagliptin induces differentiation of tolerogenic DCs, and the effect is important when considering sitagliptin for treating autoimmune diseases and allotransplant rejection.

Aim Compare the efficacy of nebulized hypertonic saline and normal saline in the treatment of infants hospitalized for bronchiolitis. Methods This retrospective study was conducted at the Department of Pulmonology, Paediatric Clinic, Clinical Centre University of Sarajevo, covering the period from January 2015 to December 2019 and comprising 380 children aged between 1 and 12 months having bronchiolitis. One group received nebulized hypertonic saline (NHS, 3% NaCl)), and another group received nebulized normal saline (NNS, 0.9% NaCl). The control group did not receive any of these treatment options. Results There was no statistically significant difference between the treatment groups regarding length of hospital stay (LOS) and Clinical Severity Score (CSS) at admission and discharge as well as in oxygen therapy duration and antibiotic use, the duration of symptoms before hospital admission, frequency of nasal discharge, elevated temperature, dyspnoea, cough and dehydration. Conclusion The results of this study are consistent with several recent studies or meta-analyses and support the evidence against the use of NHS in hospitalized infants with mild or moderate bronchiolitis.

<p><strong>Introduction.</strong> Conflict is a process during which one person consciously and intentionally makes an effort to prevent the other person&rsquo;s efforts, some kind of blockade that will lead to interruption in achieving the goals and interests of the other person. Conflicts in the healthcare team are common and can lead to reduced productivity in the work of healthcare professionals, which can have a negative impact on the care and treatment of patients. <strong>Methods. </strong>This cross-sectional study involved 100 health professionals, nurses and doctors employed in the primary, secondary and tertiary levels of health care. The research was conducted from March to August 2020. A questionnaire on socio-demographic characteristics of respondents, a questionnaire on conflicts of health professionals, and a standardized scale of depression, anxiety and stress with 21 questions (DASS-21) were used to measure the level of subjective depression, anxiety and stress <strong>Results.</strong> Seventy-four health workers (74%) had experience of conflict in the workplace, doctors (95%) significantly more often than nurses (58%) (p=0.001). Forty percent of health workers stated that communication problems were the most common cause of conflict. Seventy-nine respondents (79%) chose cooperation and compromise as a style in conflict resolution. Doctors chose cooperation more often (84%) than nurses (74%) and the difference was statistically significant (p=0.048). Subjects who had experience of conflict had significantly higher average values of anxiety (8.01&plusmn;2.12) (p=0.026) and stress (10.32&plusmn;2.91) (p=0.008) compared to subjects who had no experience of conflict (6.13&plusmn;1.91; 6.12&plusmn;2.03). <strong>Conclusion.</strong> Doctors were significantly more likely to have conflict situations in the workplace. For conflict resolution doctors were more likely to choose a style of cooperation and compromise than nurses who were more likely to choose a style of conflict avoidance.</p>