<p><strong>Introduction. </strong>Test anxiety implies an intense pathological fear in situations of preparing and taking exams which is a significant problem for 15&ndash;70% of medical students. The frequent use of psychoactive substances is recognized as a problem for young people. The aim was to determine the frequency and degree of test anxiety and the association with misuse of psychoactive substances in medical students of the Faculty of Medicine in Foča.<br /><strong>Methods.</strong> The research was conducted according to the principle of a cross-sectional study at the Faculty of Medicine in Foča. Students were offered a custom-made questionnaire containing general and specific questions for test anxiety and use and dependence of psychoactive compounds and social networks. Test anxiety was evaluated by Westside anxiety scale.&nbsp;<br /><strong>Results.</strong> The sample included 145 respondents, 69.7% females and 30.3% males. The results indicate that the degree of test anxiety does not differ in male and female students, but test anxiety is less pronounced in younger students and students with medium academic success. The level of test anxiety was correlated with the rate of psychoactive compound use. Psychoactive substances were used by 50.3% of students, primary for anti-anxiety, than for psychostimulation and for hypnotic effects. The most commonly used classes of psychoactive substances were plant anxiolytics, followed by benzodiazepines, marijuana, alcohol and narcotics/cocaine (18.6%, 12.4%, 12.4%, 8.3%, and 4.8%, respectively).<br /><strong>Conclusion.</strong> A significant number of students reach for anxiolytics and other drugs that can create addiction. Elevated levels of test anxiety are positively correlated with increased consumption of psychoactive compounds. However, the frequency of use of psychoactive compounds surpasses the frequency of altogether moderate, high and extreme test anxiety.</p>

<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>

<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.

: Satureja montana L. (SM) has a long traditional use as a spice and a medicine for various gastrointestinal disorders, including painful spasms and diarrhea. Contrary to conventional drugs, administration of SM and its extracts are considered safe. Previous studies have shown that the essential oils (EOs) of SM from different areas are rich in monoterpenes, sesquiterpenes, diterpens, and phenolic compounds, including flavonoids, tannins, and acids with great composition variability. Determination of composition of EO from Herzegovinian SM done by gas chromatography-flame ionization detection and gas chromatography mass spectrometry (GC-FID and GC/MS, respectively) revealed carvacrol as a primary substance followed by γ -terpinene, p -cymene, and β -caryophyllene. Ex vivo spasmolitic activity caused by EO was evident in different types of isolated rat ileum function with the most potent effect on spontaneous activity followed by electrical field stimulation and KCl-and CaCl 2 -induced activity. SMEO produced in vivo antidiarreal activity on castor oil-induced diarrhea in young rats and showed the potential to cause a decrese water content in the feces of adult Wistar rats.This study indicates that effects of SM on the intestinum could be mediated through combination of Kv channel activation and Ca channel blockade, but additional mechanisms might be involved. The results of this study corroborate the traditional use of SM as antispasmodic, antidiarrheal, and antisecretory agents.

Introduction: Antimicrobial resistance and the rapid spread of multiresistant bacteria represent one of the main public health problem in limited resources countries. This issue is significantly worsening since the COVID-19 pandemic due to the unreasonably increased antibiotics prescription to patients with confirmed SARS-CoV-2 infection. The aim of this study was to examine whether COVID-19 pandemic (2020, 2021) was associated with increased antibiotic consumption in inpatient and outpatient settings in the middle size urban region (Republic of Srpska/Bosnia and Herzegovina) in comparison to period before the pandemic (2019). Additionally, we aimed to determine antimicrobial resistance and the presence of multiresistant bacteria in the regional hospital (“Saint Apostol Luka” Hospital Doboj) in 2021. Methodology: The consumption of antibiotics in inpatient was calculated as Defined Daily Dose per one hundred of patient-days. The consumption of antibiotics in outpatient was calculated as Defined Daily Dose per thousand inhabitants per day. Resistance of bacteria to antibiotics is expressed as a rates and density for each observed antibiotic. The rate of resistance was calculated as a percentage in relation to the total number of isolates of individual bacteria. The density of resistance of isolated bacteria against a specific antibiotic was expressed as the number of resistant pathogens/1000 patient days. Results: Antibiotic consumption in hospital setting registered during 2019, 2020 and 2021 was as follows: carbapenems (meropenem: 0.28; 1.91; 2.33 DDD/100 patient-days, respectively), glycopeptides (vancomycin: 0.14; 1.09, 1.54 DDD/100 patient-days, respectively), cephalosporins (ceftriaxone: 6.69; 14.7; 14.0 DDD/100 patient-days, respectively) and polymyxins (colistin: 0.04; 0.25; 0.35 DDD/100 bed-days, respectively). Consumption of azithromycin increased drastically in 2020, and dropped significantly in 2021 (0.48; 5.61; 0.93 DDD/100 patient-days). In outpatient setting, an increase in the consumption of oral forms of azithromycin, levofloxacin and cefixime, as well as parenteral forms of amoxicillin-clavulanic acid, ciprofloxacin and ceftriaxone, was recorded. In 2021, antimicrobial resistance to reserve antibiotics in hospital setting was as follows: Acinetobacter baumanii to meropenem 66.0%, Klebsiella spp to cefotaxime 67.14%, Pseudomonas to meropenem 25.7%. Conclusion: Recent COVID-19 pandemic was associated with increased antibiotic consumption in inpatient and outpatient settings, with characteristic change of pattern of azithromycin consumption. Also, high levels of antimicrobial resistance to reserve antibiotics were registered in hospital setting with low prevalence of identified pathogen-directed antimicrobial prescription. Strategies toward combat antimicrobial resistance in the Doboj region are urgently needed.

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.

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.

Digitalization is introducing a virtual representation of the physical world. Such virtual or digital assets, interconnected via global communication network, open unbounded management opportunities that are realized in form of software. Nowadays, digitalization is not a matter of technology change, but is rather perceived as a prerequisite of modern and sustainable operation. Thus, proactive digitalization continuously increases the complexity of globally interconnected software systems and new emerging technologies may bring significant improvements in their management. Management and sustainable goals depend on sound and effective software system engineering solutions. In this paper, we discuss modeling complex software systems within a water supply case study, in which digitalization is introduced to accomplish sustainable goals. Our focus is on water leak report and repair process, for which we open interesting further research and development challenges, based on our previous experiences in modeling complex software systems and in modeling software failure report and repair process.

OBJECTIVE Patients and medical professionals have a common misconception that cardiovascular diseases (CVD) predominantly affect men, which can lead to less prescribing of cardiovascular drugs to women. This study examined whether there were sex differences in the administration of cardiovascular (CV) drugs in patients admitted to the intensive care unit of the Internal Medicine Clinic of Foča University Hospital (ICFUH). MATERIALS AND METHODS The study comprised 332 patients hospitalized at the ICFUH from January 1st to June 30th, 2019. The following data on leading CVD and risks related to CV drug administration were collected: age, hyperlipidemia (HLD), diabetes mellitus (DM), chronic kidney disease (CKD), liver disease (LD), heart failure (HF), hypertension (HTN), myocardial infarction (MI), and stroke (S). The amount of the CV drugs of interest (statins, antiplatelet drugs, calcium channel blockers, ACE inhibitors, beta blockers, diuretics) administered during hospitalization was expressed as the Defined Daily Dose (DDD)/100 bed-days (BD) for patients of both sexes separately. RESULTS During hospitalization in the intensive care unit of ICFUH, female patients were less likely to be treated with statins than male patients (30.1 vs. 57.5 DDD/100 BD, P<0.05). There was no difference between sexes regarding the use of antihypertensive drugs. Women were less likely to be treated by antiplatelet therapy, more precisely by acetylsalicylic acid (30.4 vs. 36.9 DDD/100 BD, P<0.05). CONCLUSION Our study indicates that there were sex differences in CV drug administration in ICFUH. Presuming that drugs used during hospitalization were at least partially a continuation of the previous therapy prescribed by the family doctor, it is possible that such differences exist in primary care.

MgSO4 is used as a tocolytic agent. It is considered to be a calcium channel antagonist, but a different mechanism of its action might be involved. The aim of this study was to examine the contribution of calcium concentrations and potassium channels in the mechanism of MgSO4-mediated uterine relaxation. Isolated uteri from female Wister rats were treated with increasing MgSO4 concentrations (0.1-30 mM). MgSO4 induced dose-dependent inhibition of spontaneous activity. Addition of Ca2+ (6 mM and 12 mM) stimulated uterine contractile activity and attenuated the inhibitory activity of MgSO4. In order to analyze the role of different subtypes of potassium channels, Ca2+-stimulated uteri were pretreated with glibenclamide (Glib), a selective ATP-sensitive potassium channel inhibitor (KATP), tetraethylammonium (TEA), a non-specific inhibitor of large conductance calcium-activated potassium channels (BKCa), and 4-aminopyridine (4-AP), a voltage-sensitive potassium channel inhibitor (Kv), at concentrations that had no effect per se. Pretreatment with 4-AP had no effect on MgSO4-mediated relaxation of Ca2+-stimulated uteri. The relaxing effect of MgSO4 was potentiated by pretreatment with glibenclamide. Pretreatment with TEA attenuated the MgSO4-mediated decrease in frequency. Our results suggest that MgSO4 acts as a general calcium antagonist that influences Ca2+-mediated potassium channels. Furthermore, it seems that MgSO4 uterine relaxation activity is partially mediated by selective ATP-sensitive potassium channels, suggesting an ATP-dependent role.

Anketa „Sto istarski srednjoskolci znaju o antifasizmu?“ provedena je u suradnji sa srednjoskolskim profesorima povijesti u drugim razredima srednjih skola (Buje, Buzet, Pula, Rovinj, Porec, Labin, Pazin) u Istarskoj županiji. Među 14 skola svih usmjerenja (od gimnazije do strukovne) bilo je 13 hrvatskih i jedna talijanska skola. Anketa je provedena od travnja do lipnja 2014., a sudjelovalo je 648 ucenika 1997. i 1998. godista, od kojih 63 % ispitanika cine žene. Anketa je sadržavala 12 pitanja visestrukog izbora (na zaokruživanje) te jedno pitanje po nacelu vrijednosnog suda. Pitanja su sadržavala povijesne podatke o nastanku, razvoju, znacenju, simbolima i položaju antifasizma na europskoj i nacionalnoj (hrvatskoj) razini u proslosti i sadasnjosti, s naglaskom na diferencijaciju prema raznim ideologijama i totalitarnim režimima (nacizam, fasizam, komunizam). Među odgovorima istice se slabo poznavanje i razlikovanje antifasistickih i fasistickih vođa te osnovne kronoloske odrednice vezane za djelovanje antifasistickog pokreta. Tako je 20 % ucenika prepoznalo Antu Pavelica kao antifasista, a Benita Mussolinija 10 %. Nadalje, 57 % ucenika smatra da se antifasizam pojavio tijekom Drugog svjetskog rata, a 17 % nakon Drugog svjetskog rata. Na pitanje koliko se u skolama uci o antifasizmu 56 % ispitanika je odgovorilo da se uci malo ili se uopce ne uci (12 % je reklo da se uopce ne uci).

Background. Pentoxifylline, used for treating peripheral vascular deceases is a derivate of methylxanthines. One way of pentoxifylline action is by causing vasodilatation of blood vessels. In this study, the effect of increasing concentrations of pentoxifylline, in the presence of potassium channel antagonist, on contractility of isolated rat uterus was examined. Methods . Uteruses were isolated from virgin Wistar rats (180-220 g) and suspended in an isolated organ bath chamber containing De Jalon's solution and aerated with 95% O 2 and 5% CO 2 . Temperature was maintained at 37oC. Isometric contractions were recorded using an isometric force transducer (Ugo Basile). The preload of the preparation was about 1g. Uteri were allowed to contract spontaneously or in the presence of Ca 2+ (0.018 and 0.36 mM ) and acetylcholine and treated with pentoxifylline. Results. Pentoxifylline caused concentration-dependent inhibition of spontaneous rhythmic uterine activity and uterine activity caused by calcium Ca 2+ (0.018 mM and 0,36 mM). We showed that the inhibitory effect of pentoxifylline depends on type of muscle contraction activation, and that it is significantly stronger in spontaneous rhythmic activity and contraction of isolated rat uterus induced by Ca 2+ . The relaxing effect of pentoxifylline depends on calcium concentration of in the medium. Pentoxifylline exerted the weakest relaxant effects on contractions induced by acetylcholine (Ach). As opposed to methylene blue, tetraethylammonium, and 4-aminopyridine, glibenclamide did not antagonize the relaxing effect of pentoxifylline on the isolated rat uterus. Conclusion. Results obtained suggest that the mechanism of action of pentoxifylline did not lead to the opening of K ATP channels. However, the opening of BKCa and of voltage dependent Ca 2+ channel had some significance, but to varying degrees, in the mechanism of the relaxing effect of pentoxifylline on spontaneous rhythmic activity and contraction of the isolated rat uterus induced by calcium. Our results are additional confirmation of the dominance of the NO/cGMP signaling pathway in the mechanism of the relaxing effect of pentoxifylline (because the presence of methylene blue significantly antagonizes its effect) in relation to the opening of potassium channels, especially K ATP channels. These results indicate that pentoxifylline could be a potential tocolytic drug. Keywords: pentoxifylline, rat uterus, potassium channel blockers, glibenclamide (GLB), tetraethylammonium (TEA), 4-aminopyridine (4-AP ), methylene blue (MB) Running title: Potassium Channels in Action of Pentoxifylline

This paper presents the basic organizational and curriculum elements of knowledge management for the environmental protection and sustainable development, based on relevant theoretical and empirical sources and knowledge. In addition to conceptual and development approach to the research problem, knowledge systems (curriculum framework) in this area are also being discussed and basic elements in organization of knowledge management practices are being emphasized. The paper presents the general knowledge management model as well as the functions of knowledge management for the environmental protection and sustainable development. Some of the international experiences and tendencies are shown in the final part of the paper, with special emphasis on the role, importance and necessity of knowledge management for the environmental protection in business organizations.