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.

Artificial intelligence has been used in the medical field for many years finding its way in assisting medical professionals to solve complex tasks in almost every application domain. Patient care and health care costs are in the forefront of any medical system. With the emergence of electronic games (EG), originally entertaining in nature, potential was seen for their application in the medical field in terms of exploring the capabilities of educating patients in the areas of need. Design of serious games emerged with a focus on helping with the patient’s therapeutic modality. Some of the medical field serious games are part of the daily work of a medical professional. With the development of mobile devices, this type of gaming has also become available to the wider population. The aim of this research was to demonstrate the possibilities and benefits of using EG in the daily clinical work of medical professionals. This work has a descriptive character where a section of the literature is given outlining the increased research interest in using serious games as therapy enhancements. We limited ourselves to research involving patients who need medical treatment or intervention.

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.

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.

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.