Objective – The aim of the paper is to present a rare and complex congenital heart defect (CHD), congenitally corrected transposition of the great arteries of the heart (ccTGA) with associated anomalies, including ventricular septal defect (VSD), valvular and subvalvular pulmonary stenosis, dysplasia of the tricuspid valve, and atrial septal defect (ASD) with first-degree atrioventricular block, which was diagnosed, monitored and successfully treated with heart surgery in an infant. Case Report – A female infant was born with 3350 grams in weight, 50 cm in length, oxygen saturation of 98%, and heart rate of 170 beats per minute. The antenatal and perinatal period was normal. CHD was verified by ultrasound at the age of 3 days. Angiotensin-converting-enzyme inhibitors (ACE inhibitors) and diuretics were introduced in therapy after one month. Cardiac surgery (Senning-Rastelli procedure with placement of an 18-mm Contegra conduit) was performed at the age of 9 months. After the operation, the infant was stable on therapy with diuretics, antiaggregants, beta blockers, and antianemic therapy with vitamin D in prophylaxis. Conclusion – ccTGA with associated anomalies is a rare, life-threatening, congenital heart disease. After birth it demands correct diagnosis, adequate follow-up, and cardiac surgery in infancy.

276 Erciyes Med J 2020; 42(3): 276–80 • DOI: 10.14744/etd.2020.86429 ORIGINAL ARTICLE – OPEN ACCESS This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Edin Begic , Slobodan Obradovic , Slobodan Jankovic , Radoslav Romanovic , Nemanja Djenic , Boris Dzudovic , Zoran Jovic , Dragana Malovic , Vesna Subota , Milena Stavric , Farid Ljuca , Zumreta Kusljugic Increased High Sensitive C-reactive Protein is Associated with Major Adverse Cardiovascular Events after STEMI Objective: This study aims to investigate whether the high sensitive C-reactive protein (hsCRP) is associated with an ejection fraction of left ventricle (EFLV) in the early phase of ST-elevation myocardial infarction (STEMI), treated with the primary percutaneous intervention (pPCI), and to establish whether there exists a relationship between its values and the presence of major adverse cardiovascular events (MACE) within six months of pPCI. Materials and Methods: In this prospective study, 357 patients who were diagnosed with STEMI and who underwent pPCI within 24 hours of pain onset were included. The following were monitored and recorded: 1) hsCRP values, which were measured between 24 and 48 hours of pPCI, 2) EFLV values, which were measured five days after the pPCI, and 3) MACE, which was established within six months of pPCI. Results: The EFLV values measured five days after the pPCI were significantly lower with increasing hsCRP values (rho=0.384, p<0.0001). There was a significant difference in hsCRP values between patients who had MACE and those without it (38.35 [98.10] vs. 12.97 [23.80], p=0.0001). In addition, hsCRP values were significantly increased in patients who died during the first six months after the pPCI compared with patients who survived (115.00 [202.80] vs. 15.84 [31.5], p=0.001). Conclusion: The hsCRP values in patients with STEMI who were treated with the pPCI are related to systolic function in the early phase of STEMI, as well as MACE during the first six months of follow-up.

The action of forces in the back and abdomen under conditions of loading of different external forces at different bending angles is unexplored area. This paper presents a methodology that enables calculation of the magnitudes of forces in the back and abdominal muscles using the combined techniques of the CATIA software system, appropriate mathematical model and polynomial regression analysis. The person of 180cm in height and 85 kg in weight is loaded with 5 + 5 kg of cargo in both hands, and three cases of bending angles of 150, 300 and 600 relative to the vertical axis are analysed.

Background: The aim of the article was to create an appropriate computer model based on the real status of the mortar operator's workplace and to analyze the workplace. After that, for any possible exceedances from the aspect of the organism's load and safety, the aim is to redesign the workplace and bring it within the limits of the permissible load, and therefore the required safety. The aim is also to identify the characteristic work movements performed by the soldier and to carry out an ergonomic analysis of the soldier's efforts and to propose appropriate improvements. Methods: The analysis is performed on a total of 20 soldiers, from which is determined an average model of the following characteristics: 180 cm in height and 85 kg in weight. The task is to take a mine from the shell containing the mines, then transfer it to the mortar and fill the mortar barrel. The weight of the 120 mm mortar grenade is 14.8 kg. The average soldier is 26 years old and his military exercise lasts 4 hours. The CATIA software package (Dassault Systemes, Velizy-Villacoublay, France) is used for analysis. By knowing the anthropometric and work environment data, with ergonomic design and analysis, the following analyses were made: biomechanical analysis, rapid upper limb assessment (RULA) and carry analysis (option from CATIA software). Results: The proposed modification of the position resulted in a decrease in the L4/L5 torque from 316 Nm to 154 Nm along with decreasing of the compression force on the L4/ L5 from 5779 N to 3038 N (the compression force allowed is 3400 N), and while the RULA analysis is from the red color position 1 (score 7; maximum load requiring rapid repositioning of such position), revised final score 4 made in yellow (a solution acceptable for this work place). Conclusions: By ergonomic analysis, obtained proposal will lead to less chance of injury, prevention of burn out syndrome, fewer chances of illness, decreasing the fatigue, greater safety, less energy spent and better preparedness for all necessary tasks.

Introduction: Investigations have shown that noise is one of the etiologic factors that leads to a risk of cardiovascular incidence. Aim: To present effect of noise on arterial tension and heart rate of workers who work on machine press during period of three-years. Methods: The study had a prospective character and included 30 subjects (n = 30) who were monitored over a three-year period (36 months). The respondents worked at the factory “Cimos” on machine press (Zenica, Bosnia and Herzegovina). Ten machine presses were monitored, and three workers worked on each press. Approximately every worker was affected by a wide range of noise between 65 and 110 dB in the workplace (via isohypse). MATLAB (version 9.4, MathWorks, Natick, Massachusetts, United States of America (USA)) software was used to estimate the possible damage caused by noise in factories that produce noise in their work. Results: During the three-year period, arterial tension in the subjects increased, and at the end of the observed period, they were considered as patients with a diagnosis of arterial hypertension grade I. The tension depends on the strength of the produced noise, and the values also depend on position of the respondent on the machine press. Conclusion: Noise prevention has become a problem of modern medicine. The result of our work allows estimation of arterial hypertension in specified time in case of exposure to a certain strength of noise. Prevention of noise, daytime noise prevention as well as better equipment for work and preventive equipment are imposed as imperative in such or similar conditions, with the need of development of national strategies for this issue in countries where they are not present.

Aim To identify short-term effects of extracorporeal shock wave lithotripsy (ESWL) on renal function in children and adolescents with single kidney stones. Methods In a 4-year period 30 children (15 boys and 15 girls) from 10 to 18 years of age were treated for unilateral renal stones with ESWL. Inclusion criteria were: up to 18 years of age, kidney stone (from 4 to 20 mm in diameter) visible on X-ray, first ESWL treatment, unilateral lithotripsy treatment without previous kidney surgery, patients without infravesical obstruction, patients without proven urinary infection, repeated use of one (the same) analgesic, patients without anticoagulant and antihypertensive therapy, patients without use of nephrotoxic drugs prior to and during the treatment, normal blood pressure, non-pregnancy patients with normal renal function. Serum enzymes (alkaline phosphatase, lactate dehydrogenase), cystatin C, serum and urine electrolytes (sodium, potassium, chloride), and urine neutrophil gelatinase-associated lipocalin (uNGAL) were tested before, on the first and fifth day after the treatment. Results An increase of alkaline phosphatase and lactate dehydrogenase was statistically significant on day 1 (p<0.05) and values returned to normal on day 5. Serum cystatin C level was also significantly increased during the first four days after ESWL treatment (p<0.05) and returned to baseline on post-treatment day 5. There was a statistically significant difference in the level of uNGAL in urine before and 24 hours after ESWL treatment (p<0.05). Conclusion The ESWL is a safe and curative procedure for the treatment of kidney stones in children and adolescents with no evidence of serious adverse effects on renal function.

Introduction: Achilles tendon injuries usually occur with abrupt movements at the level of the ankle and foot, and the consequence is the overload of the Achilles tendon. Aim: Examine the Achilles tendon load as a function of the landing angle, and find the critical point at which the tendon overload begins and when a further increase in the landing angle can lead to rupture. Methods: The study has a prospective character. The input data represent the anthropometric values of the respondents, who are professional basketball players in the senior national team of Bosnia and Herzegovina and were processed in the CATIA v5-6 software solution. Software data processing analyzed the landing angles and the transfer of force to the Achilles tendon. The end result is a regression curve, which projects the angle at which the Achilles tendon is overloaded, and indicates an increased risk of possible injury to the tendon itself. Results: The onset of overloading starts at an angle of 32.28° and at an angle of 35.75° the overloaded load occurs, indicating the need for the subject to change the position of the foot to prevent damage to the tendon itself. Conclusion: An angle of 35.75° is the critical point at which the Achilles tendons are overloaded at the very landing. Prevention of injury should go in the direction of practicing the feet for a particular position at the time of the landing, and in the direction to develop adequate footwear that would mitigate the angle at the landing.

Aim To examine the effects of therapeutic hypothermia on the outcome of patients with the diagnosis of out-of-hospital cardiac arrest (OHCA). Methods The study included 76 patients who were hospitalised at the Medical Intensive Care Unit (MICU) of the Clinical Centre University of Sarajevo, with the diagnosis of out-of-hospital cardiac arrest, following the return of spontaneous circulation. Therapeutic hypothermia was performed with an average temperature of 33oC (32.3 - 34.1o C) on the patients who had coma, according to the Glasgow Coma Scale (GCS). Results Multiple organ dysfunction syndrome (MODS) significantly affected survival (p=0.0001), as its presence reduced patients' survival by 96%. In addition, ventricular fibrillation (VF) as the presenting rhythm, also significantly affected survival (p=0.019). A degree of patient's coma, as measured by the GCS, significantly affected survival (p=0.011). For each increasing point on the GCS, the chance for survival increased twice. Moreover, other physiological factors such as the pH and the lactate serum levels significantly affected patients' survival (p=0.012 and p=0.01, respectively). Conclusion In patients with the diagnosis of OHCA who underwent to the treatment with therapeutic hypothermia, verified VF as a presenting rhythm was a positive predictive factor for their outcome. Therefore, therapeutic hypothermia represents an option of therapeutic modality for this type of patients.

Introduction: Noise represent an unwanted sound that endangers human health in multiple manners and in work setting causes reduction of productivity on one side, and increased waste on the other. Noise pollution occurs when the ear is exposed to the volume of sound that is disturbing, stressful or directly damaging hearing, but also acting on the organism as a whole. Aim: The aim of the article is to examine the vulnerability of workers working on the „press“ machine, and to carry out an analysis and examine the press operator workplace, then perform the noise spread measurement in the press operator work area and compare the current measurements with the permissible levels and analyze the time period of worker exposure, as well as presentation of the effects of noise on productivity and workers health. The aim of the article also includes the proposal for decrease of noise pollution. Methods: A noise analysis at the workplace of workers working on a „press“ machine was performed, which is exposed to a high impulse noise due to which the quality and quantity of production are reduced. For the purpose of calculating the noise level for one working day at the press operator site 1, 2 and 3, it is necessary to analyze the noise level in time. Operators spend most of their working hours at stations 1 and 3 where the measured noise level is Lm1 = 94.7 dB is taken, or at position 3, Lm3 = 97.2 dB. The measured noise level at these locations without the operation of the press is Lm1 = 80.1 dB, or at station 3 is Lm3 = 80.1 dB. Results: It was found that these operators working on the machine in question were exposed to a noise over the limit for more than three years. Their health problems that arise as a result of noise exposure are documented in their health charts. In order to achieve uninterrupted work at the press machine, during the eight hours shift, a noise correction is required to allow the equivalent sound level to fall within one day to the permissible 85 dB. In this regard, we consider the fact that we have known that the press produces a sound level of 110 dB, and that there is a reverberation (reflecting) sound. Given the technical characteristics of the plant, the reduction of the sound intensity of the source itself is not possible, so the suggestions of the technical solution will be based on reduced reflected sounds and to prevent the spread of direct sound to the operator. Conclusion: Workers are exposed to permanent noise during a working day, which produces a number of consequences for the health of the worker, but also the employer and the community. The imperative of the employer is to reduce the number of rejects, increase profitability and to have a positive impact on the health of the individual.

Background: The aim of the study was to highlight the importance of adequate anticoagulant therapy and the correlation of higher risk of stroke. Methods: This study analyzed data obtained from 103 patients with diagnosis of atrial fibrillation (AF) (39 of them had a stroke). Patients were divided into groups according to the CHADS2, CHA2DS2-VASc, and HASBLED scores. Results: An analysis showed that anticoagulant drugs were more often prescribed to subjects <75 years of age (P = 0.001). Patients with a higher CHADS2 score had a higher CHA2DS2-VASc score and vice versa (rho = 0.513; P = 0.0001). According to the CHA2DS2-VASc, 91.3% of the patients examined were prescribed an anticoagulant medication as a therapy at discharge from the hospital. The result was statistically significant compared to the practice where an anticoagulant was prescribed to 55.9% of high-risk subjects as estimated by the CHA2DS2-VASc score (P < 0.05). Our results also show that rivaroxaban is more commonly prescribed as a discharge therapy than warfarin (χ2 = 12.401; P = 0.0001). Furthermore, a significantly higher number of patients who were being prescribed aspirin (38.5%) had a stroke compared to 12.8% of patients who were being prescribed warfarin (χ2 = 12.259; P = 0.0001). Conclusions: Novel oral anticoagulants (NOACs) seem to be a better choice as a pharmacological therapy in the treatment of AF, due to a lack of adequate monitoring of patients' international normalized ratio (INR) values. CHA2DS2-VASc and HASBLED scores must be used as a part of routine clinical diagnostics when dealing with patients with AF.

Introduction: Renal vasculature is extremely sensitive to vasoconstrictor effects of endothelin (ET), while nitric oxide (NO) has special role in several pathological renal conditions. Aim: The aim of this study to examine the presence, character, and degree of changes in NO and ET levels in the serum of extracorporeal shock wave lithotripsy (ESWL)-treated patients with nephrolithiasis. Patients and Methods: This study included a total of 60 patients that were divided in two groups: Group I (n = 24), in which a total of 2000SWs were administered; 0–2 units; (0.5 units per each 500SWs), and Group II (n = 36), in which a total of 4000SWs were administered; 0–4 units; (0.5 units per each 500SWs). Results: In the Group I median NO serum concentration increased in relation to pretreatment levels (39.04 ± 8.29 μmol/L) specifically 30 min, 60 min, and 24 h following the treatment (39.11 ± 12.60), (41.80 ± 6.89), and (46.33 ± 9.03), where concentration growth after 24 h was statistically significant P < 0.01. The NO serum concentration in the Group II increased in relation to pretreatment levels (38.90 ± 10.33 μmol/L) after 30 min (48.71 ± 30.09), 60 min (54.57 ± 39.76), and 24 h (97.95 ± 72.07). The NO concentration increase after 60 min and 24 h is statistically significant, respectively, P < 0.03 and P < 0.0001. Conclusion : NO and ET serum levels are changing under the influence of ESWL, and that the NO and ET changes are directly correlated with the number of administered shock waves and administered energy.