Introduction: Plasmapheresis also known as a therapeutic plasma exchange (TPE) is extracorporeal procedure by which individual components of plasma that are harmful or blood cells can be removed from organism by using a blood separation technology. Aim: To present the results of the implementation of plasmapheresis in children in the Department of Pediatric Intensive Care of Pediatric Clinic, Clinical center of Sarajevo University, Bosnia and Herzegovina. Patients and methods: Research (period from December 2011 to June 2016) analyzed 66 plasmapheresis (11 patients–6 plasmapheresis per patient). Results: Out of 11 patients, 7 (63.6%) were girls and 4 (36.4%) were boys. The average age of patients was 11.6 ± 3.9 years (the youngest patient had 4 years and 7 months, while the oldest had 16 years and 10 months). Plasmapheresis were significantly more often done in the winter and summer. Underlying disease was in 54.5% of cases of neurological origin. The treatment was in form of receiving IVIG in 7 patients, or the application of mechanical ventilation in 6 patients. The most common complication was hypotension, which occurred in 45.5% of patients, followed by bleeding in 36.3%, hypercoagulability in 27.2% of patients and hematoma in 27.2% of patients. Lethal outcome occurred in 3 (27.2%) patients. Conclusion: Plasmapheresis represents an invasive method due to need for placement of centralized venous catheter that provides adequate blood flow during the procedure. Although complications can be serious, they are rare and are mainly related to the presence of central venous catheter, hemostasis disorders due to use of anticoagulant therapy, and hypotension of the cardiovascular system. It should be noted that for success of plasmapheresis in children multidisciplinary approach is necessary (children’s nephrologist, neuropediatrician, intensive care doctor) as well as well-trained team of doctors and nurses with the acquired knowledge and skills.

Objectives: To determine significance and sensitivity of the Free to Total prostate specific antigen (PSA) ratio (%fPSA) in diagnosis of prostate cancer and to correlate its sensitivity and specificity with diagnosis. Methods: Research included 220 patients, who had indication for biopsy (Clinic for Urology, University Clinical Center Sarajevo). Results: Average age of patients was 64.6 ± 8.1 years. Kruskal Wallis test indicates that there is a significant difference in age in relation to the diagnosis (KW χ2=12.508; p=0.006). The correlation between the %fPSA level and diagnosis is positive and statistically significant (r=0.211; p=0.002) in the sense that cancer patients have the lowest %fPSA. Analysis of the sensitivity at 95% specificity of %fPSA compared to particular diagnosis shows the highest sensitivity for prostate cancer - 20.61% (8.35-31.02) with statistically significant AUC p<0.05. Analysis of %fPSA test in detecting prostate cancer, at cut-off values ≤ 0.16, shows a sensitivity of 72.3% and specificity of 50.4 (at cut-off values <0.07, sensitivity is 8.4%, and specificity is 97.8%). Conclusion: PSA is organ specific but not cancer specific marker, whose total value, as well as the %fPSA serve as a basis, with a digitorectal exam, in the detection of prostate cancer. By increasing the cut-off values sensitivity of %fPSA increases and specificity decreases. %fPSA has a relative importance in the detection of prostate cancer, and should not be used as a guideline, without prior clinical examination.

Pulmonary hypertension is a pathophysiological state hemodynamically defined as the increase of the mean pulmonary arterial pressure above 25, or 30 mmHg at rest, measured by catheterization of the right heart. Laboratory findings usually reveals polycythemia, the ECG right ventricle hypertrophy, and x-ray characteristic of diseased branches (echocardiography and biomarkers such as B-type natriuretic peptide (BNP) and N-terminal pro-BNP hormones are potentially helpful tools in identifying PH). Echocardiography can be found the increase of the right atrium and ventricle, right ventricular hypertrophy, abnormal contraction of the interventricular septum, left ventricular diastolic dysfunction and decreased left ventricular size, with reduced volumes of systole and end diastole. Doppler confirming tricuspid regurgitation. Pharmacological therapy would represent a use: Calcium Channel Blockers, Prostacyclin Analogues, Endothelin Receptor Antagonists and Phosphodiesterase-5 Inhibitors. Alpha adrenergic antagonists, endothelial receptor subtype A (Bosentan, Tracller) with treatment of the underlying disease or anticongestive therapy, are recommended. In case of inadequate response to treatment with a specific drug, guidelines recommend the combined use of drugs from the basic three groups, using their synergism.

H-index is an index that attempts to measure the productivity and impact of published work of scientists. H-index has several advantages – it combines productivity with echo, is not sensitive to extreme values in terms of articles without citation or to articles with above-average number of citations and directly enables the identification of the most relevant articles with regard to the number of citations received. H-index has great potential in the academic community, but it still has not realistic indicator of the quality of work of one author. Authors described most used indices for scientific assessment.

Objective: To show the place and role of continuous electrocardiographic twenty-four-hour ECG monitoring in daily clinical practice of pediatric cardiologists. Methods: According to protocol, 2753 patients underwent dynamic continuous ECG Holter monitoring (data collected from the “Register of ECG Holter monitoring” of Pediatric Clinic, UCC Sarajevo in period April 2003- April 2015). Results: There were 50,5% boys and 49,5% girls, aged from birth to 19 years (1,63% - neonates and infants, 2,6% - toddlers, 9,95% - preschool children, 35,5% - gradeschoolers and 50,3% children in puberty and adolescence). In 68,1% of patients Holter was performed for the first time. Indications for conducting Holter were: arrhythmias in 42,2% cases, precordial pain in 23,5%, suspicion of pre-excitation and/or pre-excitation in 10%, crisis of consciousness in 8%, uncorrected congenital/acquired heart defects in 4,2%, operated heart defects in 3,7%, hypertension in 3,1% cases, control of the pacemaker in 1,63% and other causes in 3,5% cases. Discharge diagnosis after ECG Holter monitoring were: insignificant arrhythmias in 47,1% cases, wandering pacemaker in 21,3%, pre-excitation in 16,2%, benign ventricular premature beats in 6,3%, atrioventricular block in 3%, sinus pause in 2.2% cases and other arrhythmias in 3,5%. In mentioned period 57 cases of Wolf Parkinson White syndrome were registered, in 4,5% of patients antiarrhythmic therapy was administered. Radiofrequent ablation was performed in 23 cases. Conclusion: The development of pediatric cardiac surgery has initiated development of pediatric arrhythmology as imperative segment of pediatric cardiology. Continuous ECG Holter monitoring has become irreplaceable method in everyday diagnostics and therapy of arrhythmias in children.

Introduction: Analysis of total value of prostate specific antigen (PSAT), with the unavoidable digital rectal examination (DRE) is the basis of prostate cancer detection. Aim: The aim of this study was to determine the specificity and sensitivity of the total value of PSAT in the diagnosis of prostate cancer. The aim was also to determine the significance of PSAT in diagnosis of benign prostate hyperplasia, precancerous conditions and inflammatory and atrophic changes of the prostate. Material and methods: Data were collected from the “Register of PH biopsy” of Clinic of Urology, CCU Sarajevo. Results: Analysis of correlation between the diagnosis and the PSAT value shows statistically significant negative correlation (r =-0,186; p = 0.006) in the sense that the value of the PSAT is highest in cancer patients, and the lowest in patients with benign prostatic hyperplasia. PSAT increases with age (r = 0.152; p = 0.025). For prostate cancer optimal sensitivity and specificity for PSAT value occurs at cut off value of> 8.6 ng /mL. Values lower than 2 ng/mL and higher than 10 ng/mL are most specific, and PPV increases with increasing value of PSAT. PSAT at values of <2 ng/mL and > 10 ng/mL are at high levels of specificity, and value > 10 ng / mL is also of high sensitivity in the detection of prostate cancer, and in this moment these values represent the optimal mode for the subsequent treatment. Conclusion: PSAT has a relative significance in the detection of prostate cancer, and should not be used as a guideline without DRE.

Introduction: Diabetes is a group of metabolic diseases characterized by hyperglycemia, and represents a disease of the modern age, disease of the 21st century. Prevention of this disease is listed as imperative. Aim of this article was to evaluate questionnaires on the assessment of risk factors for Diabetes Mellitus type 2. Material and Methods: A total of 540 questionnaires handed out randomly to citizens of Canton Sarajevo of all ages, sexes and educational levels (in January 2016) were analyzed. Results: Analyzed questionnaires showed relatively low risk of getting diabetes in the next ten years in the majority of the population. These results are rather encouraging but may in some way be in confrontation with the statistics which show a rapid outburst of diabetes. Conclusion: The life-style is the main reason for such a thing to happen, and looking at these questionnaires, we might get the feeling that we really do live in a, conditionally speaking, physically active society. That, from our everyday experience is not entirely true. It would be wise to continue doing research on this topic on the territory of Bosnia and Herzegovina.

Introduction: Determination of the overall risk of coronary disease, enables the health professionals for planning the intensity of preventive action. Aim: The aim of this study is that by the results obtained using a modified algorithm with tables adopted by the European Society of Cardiology demonstrate the possibilities for assessment of the risk of coronary heart disease degree, for application to the targeted individual or risk factors groups. Material and methods: The study was conducted as a retrospective, prospective and controlled (included two groups of 200 respondents). Results: By comparing the presence of risk factors according to the representation of groups of diseases, or myocardial infarction, results showed that the European and SCORE table have significantly lower levels of risk factors, or those with sustained myocardial infarction are ranked in groups of low and present risk in relation to our algorithm which patients with myocardial infarction ranked as high and pronounced degree of risk. Results showed that the European and SCORE table significantly reduce the levels of risk or the persons with heart failure have been ranked in the group of low and present risks in relation to our algorithm which patients with coronary insufficiency ranked as pronounced degree of risk. Conclusion: Determination of the overall risk of coronary disease, enables the health professionals for planning the intensity of preventive action. The activities of primary prevention of risk factors, or already resulting disease, may be helpful in assessing the reduction in economic costs in healthcare, both due to lower morbidity, and reducing the total cost of treatment of patients with coronary disease.

Introduction: Faculty of Medicine, University of Sarajevo has officially started working on 22.11.1944, and is the oldest faculty in the medical field in Bosnia and Herzegovina. At the same time there are two systems of organization of the teaching process, the old system and the Bologna system. Aim: To analyze the implementation of the Bologna system, and making an overview of its justification. Material and methods: Answers from questionnaires from total of 459 students were analyzed (197 who had studied under the old system and 262 who studied under the Bologna system), so total of four generations of the Bologna system. They filled out a questionnaire in which they evaluated the teaching process. Student’s opinion about quality of medical education was measured by modified Lickert scale. Results: Students of old system are older than students of the Bologna process, whose average age is increasing from generation to generation, given the growing number of students who repeat a year. All students of old system repeated an academic year once or several times (p <0.05). Analysis of average grades showed statistically significant difference (p <0.05), where students in the Bologna system had higher averages than students who were studying under the old system. The presence of large number of female students, in both systems is significant (p <0.05). Out of 33 questions about satisfaction of class, 15 were answered with better average grade from students of the Bologna system. A slight improvement in the Bologna system is in terms of the evaluation of the quality of the educational process (teachers, methods, effects). The only significant progress has been proven in terms of rating the degree of computerization of the educational process–general records on enrolled students (old system vs Bologna system–3,44 vs 3,63), record of attendance (3,47 vs 3,73), obtaining certificates (3,08 vs 3,84), method of registration of exam (2,98 vs 3,71), method of practical exam (3,06 vs 3,36) and theoretical methods of taking exam (3,01 vs 3,14). Average grades where no average grade, on any issue, does not reach grade 4 of Likert Scale, talks about real problems of education in medical field. Conclusion: In a relatively large sample (four generations of students) true benefit and progress of the Bologna system has not been proven, in comparison to the old system. Bologna system has eased the students in the administrative sense by introduction of computerization of faculties, but the old problems and old questions about the organization’s process and delivery have not been eliminated.

Introduction: The most common clinical sign in pediatric cardiology is a heart murmur (organic and inorganic). Organic are sign of heart disease, while inorganic (basically divided into accidental and functional) murmurs occur on anatomically healthy heart. Aim: To determine the justification of the application of the methods of cardiac treatment. Patients and methods: Study included 116 children aged from 1 to 15 years, who were referred due to cardiac treatment to Pediatric Clinic, of Sarajevo University Clinical Center. Results: The first group consisted of children with innocent heart murmur, 97 (53 males). The second group consisted of patients with organic murmur, 19 (13 males). The average age of the first group was 7.69 (1.01–15.01) years old, and of the second group 3.15 (1.01- 8.06) years old, and there is a significant difference between these two groups (p <0.001). Medical history questions about potentially harmful habits of mother in pregnancy, found significant differences in the frequency of the existence of habits between the first and second groups of subjects (14.44% vs. 85.1%, p = 0.013). The values of the pulse of patients showed statistically significant difference (p = 0.012). The most common place of the murmurs’ appearance is the second left intercostal space. In the first group, the most common were vibratory (32.3%) and ejection (31.9%) and in the second the most common were holosystolic (73.7%) murmur. Analyzing the R/S ratio of V1, a significant difference among the two groups was found (mean 0.78 vs. the values for 1.45, p = 0.003). There is a significance in terms of developed hypertrophy of the heart cavities (BVH) between the two groups. The most common accidental murmur was classic vibratory Still’s murmurs (55.43%) and the most common congenital heart defects was ASD (36.8%). Conclusions: A heart murmur itself, should not be the purpose of auscultation. One of the tasks of pediatricians, pediatric cardiologists in particular would be to improve auscultation, as a sovereign method of heart murmurs assessment. Heart murmur assessment should be adapted to recognize whether heart murmur is innocent, or there is suspected or probable congenital heart defect.

Introduction: Acta Informatica Medica is official journal of the Academy for Medical Sciences of Bosnia and Herzegovina (from 2014 Acta Inform Med is published bimonthly). Aim: To evaluate journal “Acta Informatica Medica” in 2015 and compare findings to previous years. Material and methods: The study has retrospective and descriptive character, and included the period 2008-2015 (included 36 issues of journal). Results: A total of 83 (average 13,8 articles per journal) articles were published in Acta Informatica Medica during 2015. Analyzing the type of articles, original articles are present in majority during 2015 (68,6%) (by analyzing last eight years, 310 (67,3%) were original). During 2015, 27,7% of articles were related to the applied of Health informatics in field of clinical medicine, 63,8% preclinical medicine and 8,5% to public health. Collaboration rate in 2015 was 0,84. Most often the time required for decision on acceptance of article in 2015 is between 50 and 60 days. Articles came from 16 countries. According to scimagojr.com for 2014, Acta Informatica Medica has SCImago Journal Rank 0,166, while Cites / Doc. (2 years) parameter (widely used as impact index) is 0,70. According to GoogleScholar, h5 index is 11 and h5 median is 19. We analyzed the Acta Informatica Medica by “Publish or Perish” software - H index was 14, g index was 19 and e-index was 10.39. Conclusion: Year after year the highest number of original articles are published. Although the period of revision of articles is acceptable, the period up to two months is certainly not long, the goal is to reduce this period. Although the magazine in mentioned field found its place, although it is indexed in numerous bases, including: PubMed, PubMed Central, SCOPUS, EMBASE, EBSCO, etc. The main goal for next year is that the magazine becomes part of the Web of Science. Imperative is further internationalization of the magazine.

Introduction: Information technologies (IT) are becoming a tool without which further education of both medical students and doctors would not be possible. Aim: The aim of this paper was to analyze the use of IT in the prism of two systems, the old system and the Bologna system. Material and methods: Answers from questionnaires from total of 459 students (2012/13–2015/16 generation) were analyzed. Results: The presence of large number of female students, in both systems is significant (p <0.05). About 92% of students of the old system and 98% of students of the Bologna system use computer in everyday work (only 36% of old system and 47% of the Bologna system are using “faculties” computers). The computer is used for entertainment, education, information (via Internet) and for communication (e-mail, chat, social networks) (68.5% of the old system and 84% of students of the Bologna system have chosen all 4 offered answers). MS Word and MS Power Point are significantly more used compared to the use of MS Excel in both systems (p <0.05). The knowledge necessary to use their computers student of both systems have acquired through individual work. Students feel that they need to improve knowledge of the treatment of sub-base (76% of students of the old system and 62% of students of the Bologna system). Having analyzed the generation of 2015/16, 84.5% of students of the Bologna system and 75% of students of the old system used smartphones or tablets. The purpose of using a smartphone is, in most cases for accessing the social networks. 77.4% of smartphone users of the Bologna system, or 73.3% of the users of the old system have installed an application from the medical field. We analyzed the opinions of the availability of online course content and the degree of computerization of the study process and the possibility of electronic access to the literature - the results are not at the appropriate level. Conclusion: Education in software solutions that are connected to databases processing, must be imperative in reform of the teaching process. IT can only improve the teaching process, the organization of the education system in most eminent universities is undeniably linked to information technologies.

Introduction: Currently in Bosnia and Herzegovina there are 25 journals in the field of biomedicine, 6 of them are indexed in Medline/PubMed base (Medical Archives, Materia Socio-Medica, Acta Informatica Medica, Acta Medica Academica, Bosnian Journal of Basic Medical Sciences (BJBMS) and Medical Glasnik), and one (BJBMS) is indexed in Science Citation Index Expanded (SCIE)/Web of Science base. Aim: The aim of this study was to show the scope of work of the journals that were published by Academy of Medical Sciences of Bosnia and Herzegovina - Medical Archives, Materia Socio-Medica and Acta Informatica Medica. Material and Methods: The research presents a meta-analysis of three journals, or their issues, during the calendar year 2015 (retrospective and descriptive character). Results: During 2015 calendar year a total of 286 articles were published (in Medical Archives 104 (36.3%), in Materia Socio-Medica 99 (34.6%), and in Acta Informatica Medica 83 (29%)). Original articles are present in the highest number in all three journals (in Medical Archives 80.7%, in Materia Socio Medica 77.7%, and in Acta Informatica Medica 68.6%). In Medical Archives, 90.3% of the articles were related to the field of clinical medicine. In Materia Socio-Medica, the domain of clinical medicine and public health was the most represented. Preclinical areas are most frequent in Acta Informatica Medica. The period of 50-60 days for a decision on the admission of article is most common in all three journals, with trend of shortening of that period. Articles came from 19 countries, mostly from Bosnia and Herzegovina, then from Iran, Kosovo, Saudi Arabia and Greece. Conclusion: In Medical Archives original articles in the field of clinical medicine (usually internal and surgical disciplines) are most often present, and that is the case in last four years. The number of articles in Materia Socio-Medica and Acta Informatica Medica is growing from year to year. In Materia Socio-Medica there is a trend of growth of articles in the field of public health, while the most common articles in Acta Informatica Medica are about medical informatics.

Introduction: Medical Archives is the oldest medical journal in Bosnia and Herzegovina (B&H) (founded in 1947.). A total of 104 articles were published in Medical Archives during 2015. Analyzing the type of articles, original articles are present in majority during 2015–80.7% (in last seven years, 561 (76%) were original out of 738). In last seven years, 651 (88.2%) articles were from the field of clinical medicine (preclinical disciplines, in the last three years are more represented than in previous years). Collaboration rate in 2015 was 0,92. Articles written in collaboration of five authors (21.1 %) are found to be predominant. From year to year, most often required time for a decision on acceptance or on the revision prior acceptance is between 50 and 60 days (30% of cases in 2015). During 2015, 47.1% of articles were originally from B&H (eleven countries were represented). H index of Medical Archive for 2014 was 12, and does not vary during the last decade. Findings: In 2015 in B&H about twenty-five journals are issued in the field of biomedical and life sciences in general (six are indexed on Medline/PubMed, one is indexed in the Science Citation Index Expanded (SCIE)/Web of Science base). According to GoogleScholar the biggest h5 index has Bosnian Journal of Basic Medical Sciences (BJBMS) and Medical Archives, while the biggest h5 median has BJBMS i Acta Informatica Medica. The highest H-index (13) in B&H has Izet Masic MD, PhD, Enver Zerem MD, PhD and Semir Vranic MD, PhD, while highest g-index (22) has Enver Zerem MD, PhD (analyzed by software package “Publish or Perish”). Conclusion: By comparing the state of medical publishing in B&H with neighboring countries (Croatia, Serbia, Montenegro), we have concluded that B&H is behind Croatia and Serbia by following parameters: Total Documents, Total Cites and H index but in front of Montenegro.

Introduction: Materia Socio Medica Journal has a long history. It was founded in 1978. Aim: To evaluate journal articles in 2015 and compare findings to previous years. Material and methods: The study has retrospective and descriptive character, and included the period 2009-2015. Results: A total of 99 articles were published in Materia Socio Medica during 2015 and it shows an upward trend during the period 2009-2015. Original articles are present in majority during the last seven years (69,2%). Analyzing the last seven years, 44,1% of articles were from the field of clinical medicine. Articles from the fields of public health show an upward trend during the last four years. Collaboration rate in 2015 was 0,95. Authors of the articles are from ten countries (four continents). H index of journal is 8 and g index is 12 (Publish or Perish software). According to GoogleScholar, h5 index for Materia Socio Medica is 8 and h5 median is 9. Conclusions: The objectives of the journal in the next year are: to become a part of the Scopus and Web of Science databases, further internationalization and promotion of the journal in the country and the region, revision and broadening of the Editorial Board, trying to follow trend in reducing the number of days required for a decision on acceptance or revision of article and involvement of the younger generation of professionals and scientists into the journal work and publishing scope, which will lead to emergence of new enthusiasm and ideas (Journal intends to follow the trends of modern biomedical publishing worldwide).