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.

ABSTRACT Objectives: To examine a relationship between protein C (PC) and antithrombin III (AT III) activities with ejection fraction of left ventricle (EFLV), in the early phase of acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), and to investigate whether PC and AT III are associated with major adverse cardiovascular events (MACE) within 6 months following from pPCI. Patients and methods: The research had a prospective character and included 357 patients who had, following the diagnosis of the STEMI, undergone pPCI at the Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia, from January 2010 until April 2019. Results: The EFLV positively correlated with PC values (rho = 0.229). There was a statistically significant increase in the PC values between patients with MACE compared with those without MACE at 6 months’ follow-up evaluation (p < 0.0001). Also, significant difference in PC values between patients who died in hospital and those who were alive at 6 months’ follow-up (p < 0.01) was observed. PC values were different across different EFLV groups (p < 0.001), increasing from the 1st to the 4th EFLV quartiles: the median and the interquartile values for the 1st, 2nd, 3rd and 4th quartiles were 1.0400IU/l ± 0.15, 1.1400IU/l ± 0.15, 1.1350IU/l ± 0.16 and 1.2200IU/l ± 0.14, respectively. Conclusion: Increased PC activity in the early phase of STEMI is associated with higher EFLV 5 days after the pPCI as well as with MACE at 6 months after the pPCI.

Background: The use of trolleys for transporting the patients and lifting and lowering them in the trolley is a repeated activity in the daily work of a nurse, and a very common cause of the load of the lumbosacral part of the spine and the consequent pathological deformity, and the onset of clinical symptomatology of painful lumbo-sacral syndrome. The high level of excessive biomechanical stress is associated with the established practice of using standard medical wheelchairs to move patients inside the hospital. The process itself depends on the characteristics of the patient, his or her weight, as well as his/her cooperativeness, but primarily depends on the nurse's mobility. Although nurses strive to be in a position that reduces the load on the lumbosacral part of the spine during practice, this is often impracticable due to the patient's inconsistency. Objective: To present the ergonomic analysis of the medical nurse's workplace while lifting the patient into the wheelchair and to display solution for improving working conditions and prevention of musculoskeletal disorders. Results: By ergonomic module of this software, we got results that present load on lumbosacral region of spine of medical nurses during their daily activities, especially in the position of lifting and lowering patients. It was concluded that maximal spinal loading decreases significantly and becomes less than critical (3,100 N) in the case of a wheelchair that has ability to automatically lift and lower patient. Conclusions: The use of hospital wheelchairs with an mechanism for the automatic lifting and lowering of patients and with a sliding seat will reduce the load on the lumbosacral region of the spine, prevent the onset of lumbosacral pain syndrome, facilitates work for the medical nurse and allows nurse to handle the patient on her own. The prevention of lumbosacral pain syndrome improves the quality of work of the nurse and extends the working life. Use of this type of wheelchair is justified in terms of cost-benefit analysis.

The aim of the paper was to examine the effect of noise on the blood flow velocity through a period of three years on workers who work on press machine. It was proven that continuous exposure to noise affects the blood flow velocity through the aorta and increases the diameter of ascending aorta and this, consequently, leads to an increase in cardiovascular risk. Prevention of changes in the cardiovascular system is considered to be imperative, and the limitation of noise levels and the length of exposure to noise must be established as factors that must be planned during the construction of the work environment.

Aim To determine risk factors for deep vein thrombosis (DVT) in hospitalized patients in a 10-year follow-up. Methods In this observational study data were collected from the disease history of patients admitted to the Department of Angiology of the Clinical Centre University of Sarajevo in the period of 10 years (2008-2017). Of 6246 hospitalized patients, 1154 were with established diagnosis of DVT and included in the study as a basic inclusion criterion. Results Provoked venous thromboembolism was recorded in 45.75% of hospitalized patients. In 54.25% cases DVT was classified as idiopathic; in the remaining cases with DVT external risk factors were identified. Every fourth patient had a history of malignancy, and this risk factor was significantly more common among women and younger patients. Cancer of female reproductive organs, colon, lung, breast and prostate cancer were most common. One of 10 women had DVT during pregnancy or postpartum period. Out of the total number, 10.9% patients had DVT after surgery, 2.3% after injury. DVT was found in 1.6% of drug addicts. Rethrombosis was diagnosed in 5.2% patients within a year, while 9.2 % patients had rethrombosis within five years. Conclusion Provoked venous thromboembolism is an entity that can be prevented. Malignancy and surgical treatment are the most common risk factors and these patients should be treated with special care. The creation of a register of patients with venous thromboembolism in Bosnia and Herzegovina would enable the development of a preventive strategy in the groups of patients at risk.

Background: Sedentary behavior carries the risk of musculoskeletal problems, especially in the lumbosacral region of the spinal column.  According to modern lifestyle, this has begun to be a public health issue. Objective: To point to the health risks of working at the computer and present an ergonomic analysis of the typical and improved position of workers in front of the computer, thereby reducing the chances of emergence occupational diseases. Results:  Changing the position of the subjects led to a change in lumbar pressure from 2,818 N/m2 to 351 N/m2. Software analysis of the changed position indicates that this position is acceptable, both for the lumosacral region of the spine and for the abdominal muscles. Conclusions:  A change in body position will decrease lumbar moment and the load on the lumbosacral region of the spine. Work chair with lumbar support, the right desk height, setting the appropriate position of the monitor, selecting the optimal keyboard and mouse, dividing the workspace into appropriate zones, as well as changing lifestyle and habits should be part of the management of people who spend most of their working time in a sitting position.

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.

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 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 The period 01 03 2020 to 01 09 2020 was observed Results: Without epidemiological measures, Bosnia'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 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 © 2020 All Rights Reserved

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.

Introduction: The occurrence of recurrent venous thrombosis, despite adequate therapy, is still a topic of research in the scientific world. The site of thrombosis and the involvement of anatomical segments represent a significant factor in its occurrence. Aim: To correlate fibrinogen values with anatomical location and extent of verified thrombus in patients with recurrent deep vein thrombosis. Materials and methods: In the period January 2007-January 2020, 223 patients with recurrent deep vein thrombosis were analyzed. At admission fibrinogen values were taken. Results: There was no significant difference in fibrinogen values in relation to gender (p = 0.842). The difference in mean fibronogen values between proximal (n = 171) and distal (n = 27 = veins) were not statistically significant (p = 0.326). There was no difference between the average values of fibrinogen in relation to the number of segments (1 to 3) (p = 0.298). The largest number of patients (n = 132) had 2 segments affected, and fibrinogen values was 4.7 g/L (3.6-7.1 g/L). Male gender had slightly higher fibrinogen values than females, but without significance (p = 0.091). The age of the subjects did not correlate with fibrinogen values ( p = 0.569). Fibrinogen values according to vein anatomical localization were statistically non-significant (p = 0.201). Conclusion: Fibrinogen values were not proved to be an indicator of anatomical localization and segmental involvement in patients with recurrent DVT. Keywords: fibrinogen, venous thrombosis, prognosis.

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.