Introduction Acute psychotic disorders are increasingly being diagnosed in people addicted to PASA part of these patients develops chronic psychotic disorders for reasons that still insufficently known. Objectives The aim of the study was to determine preventive potential of antipsychotics in the development of chronic psychotic disorders as well as possible side effects of theur use. Methods The prospective retrospective qualitative study conducted in the period Septmeber 2017-September 2022.Data from medical records and electronic databases were used in the study.A structured questionnare for conductin research,a clinnical psychatic inteview,MMPI 202,tests to determine of ilegal PAS in body flluids. Results According to the results of the study adequate treatment of the underlying desease,fewer or complete abscence of relapses,social and psychoteraapeutic support had the greater effects.In the group of opiate addicts an adequate dose of supstitution therapy it often played a crucial role. Conclusions In experimental conditions the hypotesis about the preventive effect of antipsychotics on the development of psychotic disorders in peoplle addicted to PAS.On the contrary a whole series of new questions has beenopened. Disclosure of Interest None Declared

Background: Endocrine disrupting air pollutants such as sulphur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), fine particle matter (PM2.5), and ozone (O3) can affect thyroid gland function on the level of synthesis, metabolism, and the action of its hormones. Objective: The aim of this study was to establish whether increased air pollution could contribute to an increased incidence of autoimmune thyroid diseases (AITD). Methods: A retrospective analysis was conducted of the medical records of 82000 patients at the University Clinical Centre in Tuzla, Bosnia and Herzegovina. The target group of this study comprised a total of 174 patients from the Lukavac area. Daily data on concentrations of air pollutants were collected from the air quality monitoring station located in Lukavac. The study covered the period from 2015 to 2020. Results: The results of the monitoring confirmed the presence of air pollutants in concentrations above the permitted limits throughout the entire observed period. Concentrations of PM2.5, SO2, NO2, CO, and O3 were in the range of 1.90–431.40 μg/m3, 3.60-620.50 μg/m3, 3.40-66.20 μg/m3, 48.00-7002.00 μg/m3, and 0.70-89.40 μg/m3, with means of 64.08 μg/m3, 77.48 μg/m3, 22.57 μg/m3, 1657.15 μg/m3, and 31.49 μg/m3, respectively. During the six-year period, 174 cases of AITD were registered, of which 150 (86.21%) were women and 24 (13.79%) men. Hashimoto’s thyroiditis was found in 33 patients (18.97%), whilst 141 patients (81.03%) were diagnosed with atrophic thyroiditis. The highest total incidence of autoimmune thyroiditis was recorded in 2017, when it reached 99.49, 95% CI. Conclusion: The effects of chronic exposure to a mixture of air pollutants on the function of the thyroid gland are still not sufficiently well-known, but the numerical tendency towards a higher incidence of AITD in this study, albeit without statistical significance (p>0.05), still underlines the need for additional research.

Background: Bosnia and Herzegovina (B&H) is one of the countries of Southeast Europe with the lack of data about chronic autoimmune thyroid diseases (CAITD) epidemiology. Objective: This research aimed to assess incidence of CAITD in the Tuzla Canton of B&H during a 6-year period (2015–2020). Methods: We retrospectively evaluated 82,000 hospital records of inpatients and outpatients with possible thyroid symptoms residing in Tuzla Canton of B&H (total of 445,028 inhabitants). The study included patients with laboratory and clinical proof of autoimmune thyroid diseases (AITD). Incidence rates were calculated with age standardisation using European standard population. Trends in incidence were evaluated as moving three-year averages. Results: During the observed period, 1875 patients satisfied the diagnostic criteria for CAITD with male to female ratio of 1: 8.01. Median age of all cases was 46 years (interquartile range: 31 to 61) and women and men were on average the same age at the time of diagnosis. The overall standardized incidence was found to be 71.25 per 105 (%95 CI=63.36–79.15). The overall standardized incidence in men was 16.25 per 105 and 123.74 per 105 in women. In the end of the observed period, AITD prevalence was 427.52 per 105 (% 95 CI=408.17-446.87). Conclusion: There was a slight decline of incidence in our region during the observed period. This decrease might be the result of combination of various factors, mainly the Corona epidemics outbreak and emigration. On the basis of the lower incidence rate in the Tuzla Canton, one can assume that iodine prophylaxis carried out in order to eradicate goitre had satisfied expectations because there had not been any enormous increase in patients with AITD.

BACKGROUND Delirium is a syndrome that occurs in all age groups and in many clinical departments, and is most common in intensive care units. It is an emergency, in the overlapping fields of somatic medicine, neurology and psychiatry. Delirium occurs suddenly, dramatically, and requires a quick reaction, recognition and treatment. There are only a small number of studies that have reported delirium after a stroke. In our study, the goal was to determine the cognitive functionality of patients with delirium after a stroke. SUBJECTS AND METHODS This is a prospective study in which a group of 100 delirium patients in the acute phase of a stroke were evaluated for cognitive function. The control group consisted of the same number of patients with acute stroke who were not diagnosed with delirium. Neurological, neuropsychiatric and neuropsychological tests were performed in all patients at five different time periods. In these time periods, all patients were evaluated: Glasgow Coma Scale; Delirium Assessment Scale; The American National Institutes of Health Scale Assessment; Information-Memory-Concentration test; Dementia Score; Mini-Mental Test. The findings of computed tomography of the brain and magnetic resonance imaging of the brain were interpreted by a radiologist who was not familiar with the goals of this study. RESULTS Cognitive functioning of delirious patients is statistically significantly worse after three and six months, and one year from stroke compared to those without delirium. There is no statistically significant difference in cognitive functioning between delirious patients in relation to gender, age, location and type of stroke and patients without delirium throughout one year from stroke. There is no significant difference in cognitive functioning between delirious patients during one year from stroke in relation to severity and type of delirium, and statistically significantly higher degree of cognitive dysfunction has those older than ≥65 years. CONCLUSIONS Delirium significantly reduces the cognitive functioning of patients after a stroke.

OBJECTIVE To evaluate the defense mechanisms (DM) in patients with drug-resistant epilepsy and, to determine whether displacement is associated with seizures. SUBJECTS AND METHODS Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humor, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The values were compared with 50 subjects without epilepsy. RESULTS Patients with drug-resistant epilepsy use immature defensive styles significantly more (p=0.0010). Displacement have a positive correlation with frequency of seizure (p=0.0412). CONCLUSION Blaming others is a characteristic of the behavior of patients with drug-resistant epilepsy, especially if they have seizures. As such, they may be less adaptable in a micro social environment.

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.

Aim: Nosocomial infections (NIs) represent a major public health problem in developed, and even more in developing countries. Based on the origin of the pathogen, NIs are divided into endogenous caused by microorganisms of the patient’s microflora, and exogenous caused by pathogens from the patient’s environment or by the same microorganism isolated elsewhere from patient’s body. The main aim of this research was to determine the frequency, etiology and types of NIs at the Clinic for Surgery of the University Clinical Center Tuzla. Material and Methods: 5.039 patients were prospectively followed for the development of endogenous and exogenous NIs (January-December 2015). The definition of NI was performed using standardized the National Healthcare Safety Network (NHSN) criteria. Results: Based on continuous epidemiological surveillance, the incidence of NI was 3.51%; with a total of 177 registered infections, 24 endogenous and 153 exogenous. The most common NIs were urinary tract infections (UTIs) (14.29% endogenous and 85.71% exogenous) and surgical site infections (SSIs) (16.67% endogenous and 83.33% exogenous), p<0.001. Gram-negative bacteria were predominant (76.84%) over Gram-positive bacteria (23.16%). Gram-positive bacteria mainly caused bacteremia, while Gram-negative bacteria were most commonly isolated from UTIs and SSIs. The most common Gram-negative bacteria were Klebsiella pneumoniae (24.86%) and Pseudomonas aeruginosa (22.6%), and among Gram-positive, Staphylococcus aureus (10.73%) and coagulase-negative staphylococci (7.91%). Conclusion: Epidemiological surveillance is considered a key link in the program for the prevention and control of NIs. The most important, and the ultimate goal and purpose of conducting epidemiological surveillance are to reduce and eliminate the risk factors, which can lead to a reduction in NI incidence rate. Determining the endemic rates of NIs provides an objective understanding of the overall NI status in an institution as well as existing risk factors for the occurrence of these infections.

Introduction: The depression is a common mental disorder, especially after a stroke, which further aggravates the recovery. Aim: To analyze depression within 48 hours and fifteen days after ischemic stroke in relation to gender and location (brain hemisphere and brain circulation). Methods: We analyzed 40 patients (65.3±10.3 years), half of them were women. Mean age of women was 66.35±7.31 years and men 64.2±12.68 years (p= 0.5). Ischemic stroke was verified by computed tomography. Levels of depression were measured with self-estimated Zung’s scale. On the tests, score of 50 and higher verified depression. Criteria made by Domasio were used to determine location of the IS. Results: Mean value on depression scale in acute phase of ischemic stroke was 46.85 ± 8.6 and in subacute phase 43.4 ± 8 (p =0.06). In 19 (47.5%) patients (55% of women, 40% of men; p=0.3) depression was found during the first and in 10 (25%) patients (35% of women, 15 % of men; p=0.06) during the second evaluation (p<0.019). Mean value on depression in acute phase of illness in women was 49.1 ± 7.38, as well as in men 44.6 ± 9.22 (p=0.088) and in subacute phase in women 45.25 ± 8.04, as well as in men 41.5 ± 7.75 (p=0.16). Concerning location of ischemic stroke, there were no significant differences in levels of depression. Conclusion: Number of patients with post-stroke depression is significantly lower in subacute phase of ischemic stroke. Although the number of depressive women and their depression scores are higher, gender differences are not statistically significant. There is no correlation between post-stroke depression and location of lesion in acute and subacute phase of illness.

Aim To assess the relationship between the clinical sign of limited hip abduction and developmental dysplasia of the hip (DDH). Methods A research was conducted on 450 newborns at the Neonatal Unit at the Clinic of Gynaecology and Obstetrics and the Orthopaedics and Traumatology Clinic of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns' hips were performed using the Graf method on their first day of life. Results Clinical sign of limited hip abduction showed significant predictive value for DDH. There were 67 (14.7%) newborns with the clinical sign of limited hip abduction, of which 26 (5.7%) were on the left hip, 11 (2.4%) on the right hip and 30 (6.6%) on both hips. Limited hip abduction had a positive predictive value (PPV) of 40.3% and a negative predictive value (NPV) of 80.4% for DDH. Conclusion Limited hip abduction, especially unilateral, is a useful and important clinical sign of DDH. Doctors, who perform the first examination of the child after birth, would have to pay attention to this clinical sign. Newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.

Introduction: The main route of acquiring infectious blood and body fluids in hospital conditions is accidental exposure to stinging incidents. Aim: The aim of this study was to determine the epidemiological characteristics of accidental exposures to blood-borne pathogens among different professional groups of health care workers (HCWs). Materials and Methods: A cross-sectional study was conducted using the “Questionnaire on the HCWs exposure to blood and blood transmitted infections” at the University Clinical Centre Tuzla, Bosnia and Herzegovina, from the 1st of March to the 31st of December 2014. Study sample consisted of 1031 participants (65% of total employees) stratified into three occupational groups: doctors, nurses and support staff. Results and Discussion: Exposure incident was recorded in 1231 participants (54.8%) at least once in the last 12 months. An average number of exposure incidents per HCWs in total years of service was 7.07± 8.041. Out of total sample, 70% reported at least one type of exposure incident. Nurses had a higher frequency of multiple contacts compared to doctors and support staff (χ2=37.73; df=4; p<0.001). The frequency of reported incidents among nurses at the surgical departments was almost two times higher (1.7). 75.5% (778/1031) of the participants, reported not having been exposed to these incident. Doctors were significantly less likely to report exposure incidents than nurses and support staff. There were significant differences in reporting rate (χ2=32,66; df=4; p<0.001). Conclusion: HCWs in hospitals have a high prevalence of occupational exposure to blood-borne infections. Seventy percent of the HCWs is periodically or constantly exposed to or contact related to blood. Nurses are most frequently exposed occupational group among HCWs, while the lowest reporting rate on an exposure incident is among doctors.

Introduction : Inflammation represents tissue homeostasis, body's most powerful defense mechanism, almost completely non-specific with respect to the quality of noxae, and is present in any tissue. Inflammation can be acute or chronic. Acute inflammation has rapid action and short duration, from a few minutes to several days, and is characterized by exudation of fluid and plasma proteins, as well as by a dominant accumulation of neutrophils. Acute phase inflammatory markers commonly used for diagnostic purposes are C-reactive protein (CRP), erythrocyte sedimentation rate, and white blood cell count also known as leukocytes. Materials and methods: Materials used in this study were patients' laboratory results collected from laboratories in the medical institution " Health Center Donji Vakuf" in DonjiVakuf in the period from 1st February to 1st May 2015. For the purposes of this paper we analysed the values of leukocytes, neutrophils, erythrocyte sedimentation rate and the CRP. The study was carried out on a sample of 200 participants - 100 adults and 100 children. The process of determining the values of leukocytes and neutrophils was done by an automated hematology analyzer Sysmex electronic XP300 produced by the Sysmex company (Japan). To determine CRP values in adult participants, we used their blood serum and ran it through the biochemical analyzer BT 1500. Determination of CRP values in children participants was carried out from capillary blood samples using the NycoCard READER II. The erythrocyte sedimentation rate was measured using a modified Westergren method. Results : The outcome of the statistical analysis has shown that the mean value of leukocytes in children is higher compared to the same value in adults. This parameter is more varied in children (46.91%) than in adults (45.68%). The mean value of neutrophils in children is also higher compared to the same value in adults. This parameter had a higher variation coefficient in adults (58.87%) than in children (51.40%). However, the mean value of the erythrocyte sedimentation rate, after the first and second hours in adult patients is higher than in children. Variation coefficients of this parameter are higher in adult patients after the first hour, whereas they appear to be higher in children after the second hour. The Pearson bivariate correlation has shown the existence of a statistically significant relationship between the values ​​of leukocytes and neutrophils ​​in both studied groups. A positive correlation in the group of adult patients is present in the values ​​of leukocytes and erythrocyte sedimentation rate after the first and second hours, but this difference was not statistically significant. Conclusion : The results of this study have shown a high percentage of positive results with erythrocyte sedimentation rate after the 1st and 2nd hours and CRP (95%, 81% and 61%), and quite a low percentage of the reference values of leukocytes and neutrophils (33% and 26%) for the total number of participants. Partial correlation has shown that elevated values of white blood cells, as a control parameter, are associated with the combination of the values of leukocytes and neutrophils in adults (p = 0.030), as well as in children (p = 0.000). This data confirms the results of the Pearson bivariate correlation, implying that with an elevated leukocyte count, comes an increase of the value of neutrophils and CRP.

Introduction: Rubella is an infectious disease of viral etiology. It occurs in two forms, as postnatal rubella and congenital rubella. Objective: The objective of this study is to assess the scope of the epidemic of rubella in Tuzla Canton (TK) in 2010, then the incidence of disease in certain segments of the population, spatial distribution and movement in time. Material and Methods: The target population of this retrospective study was people suffering from rubella in 2010 from the Tuzla Canton. Results and Discussion: From the topographical distribution of patients with rubella in Tuzla Canton there is a strikingly large difference in the number of affected municipalities. Temporal distribution of patients with rubella is congruent with the epidemiological characteristics of rubella in terms of reporting the same. Gender structure of patients showed significantly higher numbers in males with 437 patients (67.33%), while for women there were 212 cases (32.67%). According to the age structure, the majority of the persons infected were aged 15-19, 470 of them which makes 72.5% of the total number of patients. When it comes to the vaccination status of patients, 3.7% was fully vaccinated (got 2 doses of vaccine), 7.6% was incompletely vaccinated (got one dose of vaccine), 66.4% was unvaccinated and for 22.3% vaccine status is unknown.Conclusion: An outbreak of rubella in Tuzla Canton in 2010 and the emergence of a large number of people susceptible to rubella is a direct consequence of discontinuity of vaccination programs during the war from 1992 to 1995. Keywords: rubella, epidemic, Tuzla Canton

Introduction: More than three decades after recognition of acquired immunodeficiency syndrome (AIDS) in the United States, the pandemic of human immunodeficiency virus (HIV) infection has dramatically changed the global burden of disease. Aim: The main goal of this research is retrospective analysis of epidemiological and clinical characteristics of 28 HIV infected patients, who were diagnosed and treated at the Clinic for Infectious Diseases in University Clinical Center Tuzla in the period from 1996 until the end of 2013. Subjects and Methods: Retrospective analysis was performed using the medical records of 28 HIV-infected persons. Two rapid tests were used for HIV testing: OraQuick Advance test, Vikia HIV1/2, Elisa combo test, HIV RNA test. AIDS disease was determined by using the criteria from WHO. Results: Among a total of 28 HIV-infected persons, 23 (82.14%) were males and 5 (17.86%) were females, with the male: female ratio of 4,6:1. In terms of the transmission route, a large proportion of cases were infected through heterosexual contact 19 (67.86%). At the time of the first visit, 16 (57.15%) patients showed asymptomatic HIV infection, 4 (14.28%) HIV infection with symptoms other than the AIDS defining diseases, and 8 (28.57) had AIDS. At the time of first hospital visit, the CD4 + cells count ranged from 40 to 1795/µl (conducted in 19 patients), and mean value of CD4 + cells was 365,31/µl, and mean HIV RNA titer was 287 118 copies/ml³. Of 28 HIV-infected persons 39 cases of opportunistic diseases developed in 12 patients (42.9%). In terms of the frequency of opportunistic diseases, tuberculosis (12 cases, 42.9%). Among a total of 28 HIV-infected patients, 6 (21.4%) of them died. Conclusion: This study characterizes the epidemiological and clinical patterns of HIV–infected patients in Tuzla region of Bosnia and Herzegovina to accurately understand HIV infection/AIDS in our region, in the hope to contribute in the establishment of effective HIV guidelines in the Tuzla region of B&H in the future.

Introduction: Acinetobacter baumannii is a frequent cause of infections in hospitals around the world, which is very difficult to control and treat. It is particularly prevalent in intensive care wards. Aim: The main objective of the research was to establish the application of epidemiological monitoring of nosocomial infections (NIs) caused by A. baumannii in order to determine: the type and distribution of NIs, and to investigate antimicrobial drug resistance of A. baumannii. Material and Methods: 855 patients treated at the Clinic of Anesthesiology and Reanimation, University Clinical Center Tuzla during 2013 were followed prospectively for the development of NIs. Infections caused by A. baumannii were characterized by the anatomical site and antibiotics resistance profile. Results: NIs were registered in 105 patients (12.3%; 855/105). The predominant cause of infection was A. baumannii with an incidence of 51.4% (54/105), followed by ESBL-producing Klebsiella pneumoniae with 15.2% (16/105) of cases, methicillin-resistant Staphylococcus aureus with 8.6% (9/105), and ESBL-producing Proteus mirabilis with 7.6% (8/105). According to the anatomical site, and type of NIs caused by A. baumannii, the most frequent were respiratory infections (74.1%; 40/54). Infections of surgical sites were registered in 11.1% (6/54) of cases, while bloodstream infections in 9.2% (5/54). A. baumannii isolates tested resistant against most antibiotics examined, but showed a high degree of susceptibility to tobramycin (87%; 47/54) and colistin (100%; 54/54). Conclusion: The increasing incidence of multi- and extensively drug-resistant Acinetobacter spp. emphasizes the importance of administration of an adequate antibiotic strategy and the implementation of strict monitoring of the measures for controlling nosocomial infections.