Background: Chest pain represents a prevalent complaint in emergency departments (EDs), where the precise differentiation between acute coronary syndrome and alternative conditions assumes paramount significance. This pilot study aimed to assess the HEART score’s implementation in West Balkan EDs. Methods: A retrospective analysis was performed on a prospective cohort comprising patients presenting with chest pain admitted to EDs in Sarajevo, Zenica, and Belgrade between July and December 2022. Results: A total of 303 patients were included, with 128 classified as low-risk based on the HEART score and 175 classified as moderate-to-high-risk. The low-risk patients exhibited younger age and a lower prevalence of cardiovascular risk factors. Laboratory and anamnestic findings revealed higher levels of C-reactive protein, ALT, and creatinine, higher rates of moderately to highly suspicious chest pain history, a greater number of cardiovascular risk factors, and elevated troponin levels in moderate-to-high-risk patients. Comparatively, among patients with a low HEART score, 2.3% experienced MACE, whereas those with a moderate-to high-risk HEART score had a MACE rate of 10.2%. A moderate-to-high-risk HEART score demonstrated a sensitivity of 91.2% (95%CI 90.2–93.4%) and specificity of 46.5% (95%CI 39.9–48.3%) for predicting MACE. Conclusion: This pilot study offers preliminary insights into the integration of the HEART score within the emergency departments of the West Balkan region.

Abstract This study aimed to investigate the effects of dietary supplementation with modified-hen-egg-yolk on plasma lipids and lipoprotein profiles in rats. During the four-week-experiment, 64 Wistar rats were divided into four groups of 16 (eight of both sexes), and fed commercial rat food (group C); food containing 70% commercial rat mixture and 30% freshly cooked egg yolk originating from laying hen eggs fed with 3% fish oil (group F); 3% palm olein (group P), or 3% lard (group L). The cooked egg yolk in the rat diet affected the concentrations of plasma total and LDL-cholesterol in males of the P and L groups. Cholesterol and total fat in the diet did not have a hypercholesterolemic effect on their own, but when in combination with fatty acid composition, they could contribute to an increase in plasma total and LDL cholesterol concentrations in rats. HDL-cholesterol was the most resilient plasma lipoprotein of rats to dietary treatments in our experiment. Compared to the control group, the addition of hen egg yolk to the rat diet regardless of its quality, adversely affected the values of HDL-C/TC and HDL-C/LDL-C in both males and females.

Objective: Romania began its COVID-19 immunization programme with approved vaccinations in three stages, as follows: The first step of vaccination is for health and social professionals, the second stage is for high-risk persons and the third stage is for the remainder of the general public. This study aims at assessment of knowledge, attitude and practice towards COVID-19 and vaccination against COVID-19 in the Romanian population during the third wave of the pandemic. Methods: This cross-sectional study was based on a Bosnian and Herzegovinian study on COVID-19 vaccination during the country’s third wave of COVID-19 pandemic. Results: Our study sample, dominantly female (629; 61.0%), with a bachelor’s degree (734; 71.2%), either single (539; 52.3%) or in a relationship (363; 35.2%), engaged in intellectual labour (910; 88.3%) and living in an urban environment (874; 84.8%) with a mean age of 25.07 ± 8.21 years, 294 (28.5%) people with COVID-19 symptoms and 86 (8.3%) were tested COVID-19 positive, had a mean knowledge score of 16.38 ± 4.0 with correct answer rates on questions ranging from 30.1% to 88.2%. Being single (odds ratio = 3.92, p = 0.029) or in a relationship (odds ratio = 3.79, p = 0.034), having a bachelor’s degree and higher (odds ratio = 1.61, p = 0.006) and being COVID-19 tested (odds ratio = 1.82, p < 0.001) were associated with higher knowledge test scores. Our sample had relatively optimistic attitudes towards final COVID-19 disease containment (712; 69.1%) and vaccination programmes (679; 65.9%). The majority of the sample followed socio-epidemiological measures and did not visit places of mass social gatherings (666; 64.1%) and wore masks (992; 95.7%) while being outside their home. In terms of vaccination rates, 382 (37.0%) of the individuals were presently immunized against COVID-19. Higher knowledge test scores (>15 points) (odds ratio = 1.66, p = 0.002) and positive attitudes of this study (odds ratio = 1.59, p = 0.001, odds ratio = 4.16, p < 0.001) were identified as independent predictors for vaccinating against COVID-19. Conclusion: Romanian citizens have had good knowledge, optimistic attitudes and appropriate practices towards COVID-19 vaccination during the third wave of COVID-19 outbreak in the country. Higher knowledge regarding the disease and vaccination against it not only increased attitudes towards the end of the pandemic, but also increased the willingness to be vaccinated and to avoid infection risk factors.

Glucocorticoids prevent or suppress the full inflammatory response to the infectious, immunological or physical agents by inhibiting early inflammatory events such as edema or cell exudation. The main effect of glucocorticoids on the inflammatory process is the inhibition or recruitment of neutrophils and monocytes. In this study, the effect of the glucocorticoid betamethasone on the hematological parameters of rats of the species Rattus norvegicus Berkenhout 1769 was examined in vivo. Betamethasone has been shown to affect the values of hematological parameters four hours after application and leads to a significant decrease in the prevalence of lymphocytes and monocytes, but also leads to a statistically significant increase in erythrocyte count, hemoglobin concentration and hematocrit values.

Introduction: Brain MRI scans can predict neurodevelopmental outcomes in neonates treated with therapeutic hypothermia. It is a common clinical practice to perform brain MRI before discharge, but brain MRI scans performed at around four months of age have a better prognostic value for a long-term neurological outcome in asphyxiated neonates. Aim: To identify which of three selected clinical parameters (oral feeding ability, muscle tone, history of seizure) evaluated 10 days after therapeutic hypothermia could predict the primary outcome of an abnormal brain MRI. Methods: We reviewed the medical records of neonates ≥ 36 completed weeks of gestation consecutively treated with therapeutic hypothermia who underwent brain MRI. Clinical parameters on day 10 after therapeutic hypothermia were correlated with brain MRI findings in the first 7-14 days of life. Logic regression analysis was performed using all three covariates of the clinical status, with an abnormal MRI as the primary outcome. Results: Brain MRI was abnormal in 42 (51.85 %) neonates with the following distribution of brain injury patterns: abnormal signal in the basal nuclei in 6, an abnormal signal in the cortex in 16, an abnormal signal both in the cortex and basal nuclei in 20 neonates. Out of three analyzed clinical parameters, feeding difficulty (P < 0.001, OR 8.3, 95% CI 2.9 - 28.9) and a history of seizures (P < 0.001, OR 11.95, 95% CI 3 - 44.5) were significantly associated with an abnormal MRI.  Conclusion: Neonates who were capable of full oral feeding by day 10 after therapeutic hypothermia and had no history of seizures were unlikely to have an abnormal MRI. This may be used in selective planning of pre-discharge MRI in asphyxiated neonates.

Aim: The chief aim of this study was monitoring of laboratory parameters of chronic kidney failure in elderly patients. Methods: All samples were taken and processed by standard methods and according to the principles of good laboratory practice. Data were collected in an organized and systematic manner in the form of a questionnaire with respect to ethical principles and as such were analyzed by statistical tests and analyses (Student's t-test, Analysis of variance-ANOVA, Pearson's and Spearman's correlation coefficients). The limit of statistical significance was set at p < 0.05. Results: Mean values of creatinine clearance and proteinuria for the total study population were: 41.30 ± 21.43 mL/min, 1.5 ± 2.3 g/L/24 h, respectively. Hematological parameters did not significantly differ from normal values. The highest frequency of comorbidities was observed in subjects aged ≥ 80 years with an average of 2.03 comorbidities per subject. Serum creatinine and urea values as well as creatinine clearance are good indicators of disease progression. Conclusion: The results of the presented research suggest that old age is a predisposing risk factor for the development of chronic kidney disease, and that in combination with comorbidities (hypertension and/or diabetes), it contributes to poor prognosis or disease progression.

Aim To investigate the association of ABO blood types and appearance of myocardial infarction (MI) among the population in Bosnia and Herzegovina. Methods This was a cross sectional study conducted at the Department for Cardiovascular Surgery at the Clinical Centre of the University of Sarajevo from January 1st to December 31st 2019. Patients were divided into two groups, defined by their blood type, A (N=91) and non-A (N=109). ABO blood groups were determined using standard agglutination techniques. Information regarding history of MI was taken from their medical documentation during the preparation for surgery. Results In total 200 patients were involved in this study. The study sample consisted of 151 (74.5%) males and 49 (25.5%) females. Mean age was 62.98 ± 7.73. Various risk factors associated with myocardial infarction were tobacco 92 (46.0%) and alcohol 54 (27.0%) consumption, obesity 77 (38.5%), diabetes mellitus 47 (23.5%) and hypertension 91 (45.3%). Being A blood type (OR=3.308; 95% Cl 1.317-8.311; p=0.011) and being male and having hypertension (OR=3.086; 95% Cl 1.262-7.545; p=0.013) significantly increased the risk for the development of MI among young adults. Patients with A blood type were significantly younger [median 58.0 vs. 63.0; U = 2738.5; p =0.027] when they developed MI compared to non-A blood type. Conclusion The age of myocardial infarction occurrence in the population of Bosnia and Herzegovina is lower in patients with blood group A compared to non-A blood types.

Necrotizing pneumonia in children is a rare and severe complication of bacterial community-acquired pneumonia. Main characteristics are a loss of normal lung parenchyma and formations of multiple thin-walled cavities filled with air or fluid. Treatment with antibiotics broad spectrum and pleural drainage is often enough, and children get fully recovered in 5-6 months after diagnosis. The child was admitted to our clinic with 38.5 C and irritating cough, misdiagnosed and treated before as pneumonia. On the x-ray of the chest was left homogenous shade. Abdominal ultrasound showed locally pleural effusion. CT scan showed multilocular denser fluid encapsulated in left hemithorax and acted compressively to the mediastinum and suppresses it to the right. Laboratory findings indicate elevated erythrocyte sedation, leukocytopenia, thrombocytopenia, elevated serum amylase, lipase, amylase in thoracic drainage content, amylase in urine, also reduced values of haemoglobin, MCV, MCHC, urea, creatinine. We gave to patient meropenem and vancomycin. And patient after 24 hours became afebrile with 90 ml haemorrhagic content in a pleural drain. CRP was declining. The radiograph of the chest shows a re-expansion of the lungs with an elevated left diaphragm. Necrotizing pneumonia can be successfully treated with antibiotics and pleural drainage without major surgical procedures.

Aim The aim was to show rare cases of congenital cystic adenomatoid malformation (CCAM) and the manner of its surgical treatment with video-assisted thoracoscopic surgery (VATS). Methods Two male and one female child, 7, 4 and 3 years of age were treated for symptoms of cough and high temperature in district hospitals. In all three children laboratory blood tests and chest radiography were done. Auscultatory findings showed the presence of pneumonia. Children were treated with appropriate doses of antibiotics. After the rehabilitation of inflammation, they were sent to the University Clinical Center Sarajevo, where video-assisted thoracoscopic lobectomy (VATS) was indicated after computerized tomography (CT). Results Chest CT scan pointed to the CCAM and pulmonary sequestration (PS) changes to the lungs. This has required surgery lobectomy of an affected part of the lungs. In two children with PS, the aberrant systemic artery came from the most proximal part of aorta abdominals, the third patient did not have an anomalous artery. Conclusion VATS lobectomy is an alternative to the traditional thoracotomy for the treatment of CCAM and PS, however, it should be investigated in the future for its safety and effectiveness.

OZET KANSER TEDAVISINDE KULLANILMAK UZERE siRNA YUKLU MANYETIK NANOPARTIKULLERIN URETIMI VE KARAKTERIZASYONU AMINA SELIMOVIC Yuksek Lisans, Biyomuhendislik Tez Danismani: Prof. Dr. Emir Baki Denkbas Haziran 2017, 73 sayfa Kanser, gelismis ve gelismekte olan ulkelerde onde gelen olum nedenlerinden biridir ve sigara icme, fiziksel hareketsizlik ve beslenme aliskanliklari gibi faktorler kanserin gelisme olasiligini arttirmaktadir. Kromozomlarin yeniden duzenlenmesi nokta mutasyonu ve gen amplifikasyonu, kinaz inhibitorleri, buyume faktorleri, reseptorler, transkripsiyon faktorleri kaskadini ve sinyal iletim elemanlarini etkileyerek hucre proliferasyonunun bozulmasina ve islev degisikligine neden olur. Bu eylemler, neoplazi adi verilen hucrelerin anormal buyumesine neden olur. Kanser tedavisinde nanoteknolojiye dayali yaklasim, terapotik araclarin guvenligini ve etkinligini arttirarak yeni nesil stratejiler gelistirmede buyuk bir avantaj saglamaktadir. Onemli olcude terapotik potansiyele sahip olan RNA interferans (RNAi) mekanizmasi, kucuk cift sarmalli RNA'larin sekansa spesifik post-transkripsiyonel gen susturulmasina yol acan yuksek etkili regulator olarak bilinir. Bu mekanizma ile spesifik genlerin ekspresyonlarinin inhibe edilebilecegi kanitlanmistir. RNAi yolaginin bir parcasi olan kucuk interfere edici RNA (siRNA) cesitli genetik hastaliklarin yani sira kardiyovaskuler hastaliklar ve cesitli kanserleri tedavi etmek icin kapsamli bir sekilde incelenmistir. Ancak, siRNA'lar hucrelere verildiginde polianyonik yapisi nedeniyle hucre zarini etkin bir sekilde gecemez. Bu nedenle siRNA'nin hucre icindeki spesifik hedefe ulasabilmesi ve enzimatik parcalanmadan korunmasi icin tasiyici sistemlere ihtiyac duyulmaktadir. siRNA icin uygun tasiyiciyi secmek icin biyouyumluluk, terapotik etkinlik, uretim kolayligi gibi ozellikler oldukca onemlidir. Bu calismada, demir oksit nanoparcaciklarin dogal biyopolimer jelatin ile kaplanmasi, hucresel proliferasyon yolaginda etkin olan mTOR geninin inhibisyonunu saglayan siRNA’larin bu yapilar ile etkilestirilmesi ve kolon kanseri hucrelerinde terapotik etkinligin saglanmasi hedeflenmektedir. Bu amacla, demir oksit nanoparcaciklari ve jelatin kapli demir oksit nanoparcaciklari sentezlenmis, optimizasyon parametreleri ve karakterizasyonlari degerlendirilmistir. Parcaciklarin morfolojik incelemesi SEM (Scanning Electron Microscopy) analiziyle ortaya konmustur. Uretilen nanoparcaciklarin boy-boy dagilimlari ve yuzey yukleri Zeta-Sizer kullanilarak elde edilmistir. Nanoparcaciklarin kimyasal yapilarini belirlemek icin molekuler bag karakterizasyonu Fourier Transform Infrared Spectroscopy (FTIR) olcumleri alinmistir. Hazirlanan parcaciklarin manyetik ozellikleri VSM (vibrating sample magnetometer) ve ESR (electro spin resonance) teknikleriyle degerlendirilmistir. Jelatin kapli demir oksit nanopartikulune hedef siRNA’lar yuklenmis ve (%) baglanma verimleri elde edilmistir. siRNA yuklu nanoparcaciklarin model kolon kanseri hucre hatti, Caco-2 ve fare fibroblast hucre hatti, L929 hucreleri ile etkilesimleri yapilmistir. Farkli konsantrasyonlarda yuklenen siRNA’larin ve hucrelerle inkubasyon surelerinin etkisi incelenerek, hucrelerde sitotoksite calismalari MTT analiziyle ortaya konmustur. MTT testi ile, siRNA-jelatin-demir oksit nanopartikullerinin her iki hucre hatti uzerinde herhangi bir tasiyici kullanilmadan verilen siRNA’lara gore toksik etkisinin onemli derecede fazla oldugu gosterilmistir. Ayrica elde edilen sonuclara gore seztezlenen nanopartikuller ticari siRNA tasiyicisi olarak kullanilan HiperFect ile benzer antikanser etkinlik gostermistir. Sunulan calisma ile kolay sentezlenen, ucuz ve biyouyumlu jelatin kapli demir oksit nanopartikullerin siRNA tasiyicisi olarak umut vaad eden sistemler oldugu gosterilmistir. Anahtar Kelimeler: nanoonkoloji, demir oksit nanoparcaciklari, jelatin, siRNA

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Aim: The aim of this research is to show why is it important in diagnosing children with lung infiltrates. Methods: Our study included 50 children with lung infiltrates during period 2005-2012, and was conducted on Pediatric Clinic of the University Clinical Center Sarajevo. We sent all cytological BAL analyses to the University Clinical Center Sarajevo. Cytology was performed by direct microscopy. BAL cytology was performed by the principle of sending samples for centrifuging, 12000 revolutions during a 10 min Shandon-cyto spin. Then the centrifuged sample is dried in the air during 1-2 hours, and is then dyed under the May-Grünwald-Giemsa staining, and analyzed under the Olympus BX41 microscope. Results: Nosocomial pneumonia has occurred in 32% children, acquired pneumonia in 38%, and 30% children had a lung infiltrates. 6 (12%) of children were younger then 1 year old, 23 (46%) children were between 1 to 5 years, 14 (28%) of children were between 5 to 10 ages, and 7 (14%) of children were between 10-15 ages. The most of the changes in observed children took place on the right lung, 34%, while 26% occurred on the left side, 22% were normal and 18% changes have affected both lungs, right and left. Percentage of cells in cytological smear in children with BAL were: cylindrical cells 28%, lung macrophage 26%, lymphocytes 17%, detritus 17% and phlegm 12%. Erythrocyte sedimentation rate (ESR) in children with BAL was up to 10-52%, to 50-30%, while ESR after first hour was above 50-18 %. Conclusion: Clinical parameters and local inflammation of the affected lobe are associated with positive bronchoalveolar cytology lavage findings.

Objective: The purpose of our retrospective study was to investigate the necessity of some laboratory testing in patients with acute bronchiolitis before and after treatment. Methods: We have taken blood samples of all children puncturing the cubital vein, and analyzed it using the Colter appliances-automatic counter blood count, for analyzes of some erythrocytes, leukocytes, platelets, differential blood count, Hct, Hb. CRP concentration in serum of patients determined by laser nephelometry with CardioPhase® high sensitivity C-reactive protein (hsCRP). For assessment of acid-base status and arterial blood gas analysis were used ABL5 and ABL700 Radiometer Copenhagen. We monitored the following parameters: pH, pCO2, HCO3−, total CO2, base excess, pO2, SpO2. Results: There was a significant improvement of hypoxemia after management of acute bronchiolitis in the form of a significant increase in average values of pO2 and SpO2 after treatment of acute bronchiolitis. The mean value of the number of leukocytes and value of CRP in children were significantly decreased before and after management of acute bronchiolitis. There was no significant difference in duration of hospitalization in term and preterm newborns. Conclusion: No diagnostic tests are used routinely. However, there is an improvement of hypoxemia after management of acute bronchiolitis in children.