Introduction: A promising strategy that can lead to longer brain cell survival after an acute stroke is therapeutic hypothermia. It represents a controlled decrease in body temperature for therapeutic reasons. It is increasingly represented as a therapeutic option and is one of the most challenging treatments that improves neurological recovery and treatment outcome in patients with acute stroke. Aim: To examine the effect of therapeutic hypothermia on liver enzymes in patients with diagnosis of stroke. Methods: A total of 101 patients diagnosed with acute stroke were treated. The first group (n=40) were treated with conventional treatment and therapeutic hypothermia, while the second group (n=61) only with conventional treatment. Cooling of the body to a target body temperature of 34°C to 35°C was performed for up to 24 hours. Outcome (survival or death) of treatment was monitored, degree of disability was determined by National Institutes of Health Stroke Scale (NIHSS) and assessment of consciousness using the Glasgow Coma Scale (GCS). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were taken at admission, after 24 hours, and were monitored upon discharge. Results: There was a significant difference in AST values at admission relative to disease outcome (p = 0.002), as well as for ALT (p = 0.008). In patients treated with therapeutic hypothermia, mean AST values decreased after 24 hours (32.50 to 31.00 IU/mL) as well as ALT values (27.50 to 26.50 IU/mL), without statistical significance. In the group of subjects who survived with sequela, AST values correlated with GCS (rho = -0.489; p = 0.002) and NIHSS (rho = 0.492; p = 0.003), ALT values correlated with GCS (rho = -0.356; p = 0.03) but not with NIHSS. Conclusion: AST and ALT values at admission correlate with the severity of the clinical picture. Therapeutic hypothermia is hepatoprotective and lowers AST and ALT values.

Dilatation and percutaneous coronary intervention in the presence of calcified lesions is particularly demanding and presents a challenge in the daily work of an interventional cardiologist. Coronary calcification is a marker of the progress of the atherosclerotic process. The existence of calcifying lesions predicts a poorer clinical outcome and is associated with increased mortality and the occurrence of postprocedural major adverse cardiovascular events (MACEs). A male patient who was 61 years old was admitted as a result of ST-elevation myocardial infarction (STEMI) complicated by cardiac arrest caused by in-stent thrombosis of a previously suboptimally expanded stent. The lesion did not respond to a dilation attempt with a noncompliant (NC) balloon; however, an optimal result was obtained with inflation from a super-high-pressure NC balloon (OPN NC) for ultra-high-pressure inflations. Resistant, calcified lesions require a careful and comprehensive approach. The OPN NC balloon has a place in the treatment of this type of lesion. An optimized therapeutic modality after the procedure is imperative to prevent a MACE.

1 Department for Architectural Structures and Building Technologies, Faculty of Architecture, University of Sarajevo, Patriotske lige 30., 71 000 Sarajevo, Bosnia and Herzegovina 2 Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Patriotske lige 81., 71 000 Sarajevo, Bosnia and Herzegovina, email: nedim_begic91@hotmail.com 3 Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Kranjčevićeva 12., 71 000 Sarajevo, Bosnia and Herzegovina, email:edinbegic90@gmail.com 4 Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, 71 000 Sarajevo, Bosnia and Herzegovina, email:edinbegic90@gmail.com 5 Faculty of Medicine, University of Tuzla, Univerzitetska 1., 75 000 Tuzla, Bosnia and Herzegovina, email: zumreta.kusljugic@ukctuzla.ba 6 Department for Pathophysiology, Faculty of Medicine, University of Sarajevo, Čekaluša 90, 71 000 Sarajevo, Bosnia and Herzegovina, email:damir.secic@mf.unsa.ba

Abstract Objectives The aim of the study was to determine carotid intima-media thickness (CIMT) values in patients who developed and did not develop preeclampsia (PE), and to determine whether CIMT values could be predictors of PE development. Methods The study included pregnant women who were examined by regular ultrasound examination at the Materno-Infantil Presidente Vargas Hospital (HMIPV) in Porto Alegre, Brazil, from April 2016 to September 2017. The examinations were performed every three months. Patients were divided into two groups. The first group included patients diagnosed with PE (n=21) and second group included patients who did not have PE (n=199). A high frequency ultrasound device (12 MHz) with a semi-automatic method was used to estimate CIMT. Results CIMT was significantly higher in pregnant women with PE than in women without PE (55±0.11 vs. 0.44±0.06, respectively; p<0.001). Using a cut-off value of 0.51 mm, CIMT had a specificity of 77.9% and sensitivity of 81% in the diagnosis of PE. With CIMT ≥0.6 mm, the probability of a patient developing PE was 44.4%; with CIMT >0.42 mm, the probability was only 4.2%. Conclusions An increase in CIMT was associated with the onset of PE. CIMT values were significantly higher in patients who develop PE.

Introduction: Mathematical modeling of coronavirus disease spread and computer simulations are currently one of the main tools in public health that can give important indicators for prevention planning. Based on mathematical projections and daily updates of information, the measures are either tightened or reduced, in order to protect the health of the population. Aim: The aim of this paper is to present a computer system based on an adequate mathematical model that allows frequent execution of various scenarios of spread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in any period in the future. Also, the aim of this article is to point out the importance of measures for the prevention of coronavirus disease 2019 (COVID-19) in Bosnia and Herzegovina through examples of computer simulation models. Methods: Software solution based on the USLIRD model (Unpopulated - Susceptible - Latent - Infectious - Recovered - Deceased) was developed, with a number of variable parameters ‘reproduction number, delay period, infectivity period, hospital capacity, characteristics of population). By setting these parameters in accordance with the existing and available data, the model is brought to an optimized state with the possibility of a realistic assessment of the course of the infection curve in any future period. Data from the beginning of the pandemic are collected at the Faculty of Mechanical Engineering, University of Sarajevo and updated several times a day. The set of measures is divided into two types. 'Intervention 1' is a measure to close institutions that are at high risk for pandemics, working from home, wearing face mask, enhanced hygiene when entering facilities with a larger number of people. 'Intervention 2' presents restrictive measures that has been introduced as mandatory in Bosnia and Herzegovina. The period 01.03.2020 to 01.09.2020 was observed. Results: Without epidemiological measures, Bosnia and Herzegovina's health system would quickly collapse. Restrictive measures reduce the intensity of the spread of the infection, save human lives and keep the health system functional, but with consequences on other aspects of society - reduction of economic activities, collapse of the service industry and companies and disorders in mental health status of the population. Four different scenarios of the situation were analyzed. Scenario number three is current condition with measures that are currently in Bosnia and Herzegovina. The reintroduction of restrictive measures leads to a decrease in the number of infected population and suppression of the spread of the pandemic, which is shown in scenario 4. Conclusion: Self-discipline, adherence to measures, while trying to avoid restrictive measures should be the way to fight the COVID-19 pandemic. Whatever the consequences, the initiation of restrictive measures to preserve the health of the population should be imperative.

BACKGROUND Alzheimer's disease is a complex disorder of unclear etiology that develops in the elderly population. It is a debilitating, progressive neurodegeneration for which disease-modifying therapies do not exist. Previous studies have suggested that, for a subset of patients, dysregulation in hemostasis might be one of the molecular mechanisms that ultimately leads to the development of neurodegeneration resulting in cognitive decline that represents the most prominent symptomatic characteristic of Alzheimer's disease. OBJECTIVE To examine a relationship between factors that are part of coagulation and anticoagulation pathways with cognitive decline that develops during Alzheimer's disease. METHODS SOMAscan assay was used to measure levels of coagulation/anticoagulation factors V, VII, IX, X, Xa, XI, antithrombin III, protein S, protein C, and activated protein C in plasma samples obtained from three groups of subjects: 1) subjects with stable cognitively healthy function, 2) subjects with stable mild cognitive impairment, and 3) subjects diagnosed with probable Alzheimer's disease. RESULTS Our results show that protein levels of coagulation factor XI are significantly increased in patients who are diagnosed with probable Alzheimer's disease compared with cognitively healthy subjects or patients diagnosed with mild cognitive impairment. Furthermore, our results demonstrate that significant predictors of Alzheimer's-type diagnosis are factors IX and XI-an increase in both factors is associated with a reduction in cognitive function. CONCLUSION Our study justifies further investigations of biological pathways involving coagulation/anticoagulation factors in relation to dementia, including dementia resulting from Alzheimer's-type neurodegeneration.

Aim To determine a status of systolic function in patients with diabetes mellitus (DM) type 2 with ST-segment elevation acute myocardial infarction (STEMI), to determine values of cardiac biomarkers in patients with DM type 2 with STEMI and correlate the parameters with ejection fraction of left ventricle (EFLV). Methods A total of 80 patients were divided into two groups, the study group (group I) consisting of 40 patients admitted with the diagnosis of DM type 2 and STEMI, and a control group (group II) with 40 patients with STEMI without diagnosed DM type 2. Cardiac biomarkers - creatine kinase MB fraction (CKMB), and troponin I were monitored. The EFLV was evaluated echocardiographically (using Simpson method) five days after primary percutaneous coronary intervention (pPCI). Results In the group I the EFLV five days after pPCI was significantly correlated with troponin values (with a minimum r = -0.47; p=0.002, a maximum r = -0.339; p = 0.032, as well as with an average value of r = -0.389; p=0.013), and with an average CK value (r = -0.319; p=0.045). In the group II there was a significant negative correlation of EFLV with the maximum value of troponin (r = -0.309; p=0.05). Conclusion Troponin values have an effect on the EFLV after STEMI, and thus on the left ventricular status, as well as on the pharmacological modality itself.

Aim To evaluate a correlation of serum level of neutrophil gelatinase-associated lipocalin (NGAL) to the risk of the occurrence of complications in patients with the early phase of ST-segment elevation myocardical infarction (STEMI) treated with fibrinolytic therapy prior to percutaneous coronary intervention (PCI). Methods A total of 54 patients with the diagnosis of STEMI treated with fibrinolytic therapy (alteplase) prior to PCI were included. Patients were admitted to the Intensive Care Unit (ICU) of Clinic for Heart, Blood Vessel and Rheumatic Diseases in the period January to March 2018. All patients underwent coronary angiography and PCI within the maximum of 48 hours delay after fibrinolysis, according to the hemodynamic and electrical stability and PCI availability. Blood samples were taken immediately after admission prior to fibrinolytic administration. Patients were divided into two groups according to NGAL values (less or more than 134.05 ng/mL). Results Higher values of NGAL have effect on a higher mean systolic and diastolic pressure (p=0.001 and p=0.003, respectively). Patients with higher NGAL values also have higher values of brain natriuretic peptide (p=0.0001) and highly sensitive troponin I (p=0.002). In that group relative risk (RR) for lethal outcome was 6.4 times significantly higher (p=0.002), for the development of heart failure 2.88 times (p=0.0002), for post-myocardial infarction angina pectoris 2.24 times (p=0.0158), and for ventricular rhythm disturbances (ventricular tachycardia, ventricular fibrillation) 1.96 times higher (p=0.0108). Conclusion Increased NGAL value is related to an unfavourable outcome of patients in the early phase of STEMI treated with fibrinolytic therapy prior to PCI.

Introduction: A Holter blood pressure monitoring is a basic method for the diagnosis and evaluation of hypertension therapy. Hypertension in children and adolescents is defined as an increase of systolic/diastolic pressure, which is equal, or above 95th percentile blood pressure for sex, age, and height. Aim: The aim of this study is to analyze the etiology of arterial hypertension (AH) in the pediatric population. Methods: Research had descriptive and retrospective character. During the period from March 2006 to April 2020, 1527 registered continuous Holters of blood pressure were analyzed. Data were taken from the medical documentation of patients that were hospitalized on Pediatric Clinic (register of continuous Holter of blood pressure). Results: Out of the total number of registered and analyzed patients 833 were male (54.5%) with dominant age 15–19 years of life 774 (50.6%), school-age children 660 (43.2%), preschool children 93 (6.1%). We had 902 (59%) first registrations and 626 (41%) control registrations. AH was verified in 52 patients (387 records of continuous Holter of blood pressure were performed to them). Primary AH was verified in 27 patients and secondary AH in 25 patients. Forty patients (76.9%) were treated with monotherapy while combined therapy was used in 12 (23.1%) of cases. Renal cause was in 28% patients, endocrine in 24%, cardiovascular in 24%, neurological in 16%, and rheumatic in 8% of patients with secondary AH. Conclusion: Continuous Holter of blood pressure represents useful diagnostic method and method of control of high blood pressure in children and adolescents. It should be routine method in everyday pediatric clinical practice especially in pediatric cardiology.

Long QT syndrome (LQTS) is a rare (1:2500–1:10,000) inherited disorder characterized by the onset of arrhythmogenic syncope, polymorphic ventricular tachycardia, and sudden cardiac death. The aim of this article was to describe an unexpected success with an unusual therapeutic modality of a patient diagnosed with LQTS syndrome (suspected Romano–Ward syndrome) during an 8-year period. A 59-year-old female patient was admitted to the hospital due to chest pain and nausea, and after diagnostic and therapeutical approach, a permanent dual-chamber rate-modulated (DDDR) pacemaker was implanted instead of the implantable cardioverter defibrillator (ICD). During the 8-year period, the patient remained stable, without rhythm disorder. Romano–Ward syndrome as a congenital LQTS carries a high risk of sudden cardiac death and presents an indication for ICD. In this patient, for objective reasons, this could not be performed. Implantation of a DDDR with an appropriate pharmacological therapy, including propranolol, in this case, proved to be a successful therapeutic modality.

Introduction: The head-up tilt table test is noninvasive diagnostic procedure, which is used in the diagnosis of syncope. Syncope presents a benign short-term disorder of cerebral circulation with the sudden loss of consciousness and muscle tone. Aim: The aim is to present not only the role and importance of orthostatic tests in the daily clinical practice of pediatric cardiology, neuropediatrics but also pediatrics in general. Patients and Methods: This study has retrospective descriptive character and included the period from April 1997 to June 2020, during which the registration and analysis of orthostatic stability tests (head-up/tilt table test, tilt table test) was performed. Medical documentation of outpatient and hospitalized patients on the Paediatric Clinic of Clinical Center University of Sarajevo (Register of Tilt Table Test) was used. Results: During this period, 1029 tests were registered and analyzed. Modification test (head-up) was performed in 132 (12.8%) patients, and since 2008, classic tilt table test was performed in 897 (87.1%) patients. Patients were 6.5–19 years old, with a predominance of female patients 611 (59.4%). There were 519 (50.4%) patients who were 15–19 years old and 510 (49.6%) patients who were under 15 years of age. Indications were syncope or suspected syncope in 671 (65.2%) patients, cardiovascular etiology (arrhythmias, chest pain, congenital heart defects [CHDs], surgically corrected CHDs, hypotension, and hypertension) in 195 (19%) patients, neuropediatric pathology (epilepsia, suspected epilepsia, headache, vertigo) in 101 (9.8%) patients, and other indications in 62 (6.03%) patients. From the total number of tests, 862 were first tests (83.4%) and 167 were control tests (16.3%). The positive test was found in 538 (52.3%) patients, most often vasovagal syncope (473 patients or 87.9%). Conclusion: Tilt table test is a reliable diagnostic tool in examining the etiology of syncope, primarily vasovagal, and is an extremely important method primarily in cardiopediatric and neuropediatric daily diagnostics.