This study examines the correlation between vitamin D levels and the severity of symptoms and quality of life in patients with benign prostatic hyperplasia (BPH). A total of 125 participants were categorized based on their prostate symptoms (mild, moderate, and severe) and vitamin D levels (deficient, insufficient, and optimal). Among those with mild symptoms (n=60), 37.93% were vitamin D deficient, 44.11% had insufficient vitamin D, and 54.83% had optimal levels. For moderate symptoms (n=55), 44.82% were deficient, 47.05% had insufficient, and 41.93% had optimal vitamin D levels. In severe cases (n=10), 17.04% were deficient, 8.82% had insufficient, and 3.22% had optimal vitamin D levels. Overall, 23.02% of participants were deficient, 27.02% had insufficient, and 49.6% had optimal vitamin D levels. Quality of life assessments revealed that 56.8% of participants reported a good quality of life, with 46.66% of these being vitamin D deficient, 57.57% insufficient, and 61.29% optimal. An indifferent quality of life was noted by 29.6% of participants, with 28.57% deficient, 27.27% insufficient, and 29.03% optimal vitamin D levels. A very poor quality of life was reported by 13.6% of participants, with 21.42% deficient, 15.15% insufficient, and 9.67% optimal vitamin D levels. These results indicate a potential association between higher vitamin D levels and improved prostate symptoms and quality of life in BPH patients. Further research is needed to establish causality and underlying mechanisms.

Antibiotics are medications that inhibit bacterial growth and are used in the treatment of bacterial infections, both gram-positive and gram-negative. Antibiotics also represent products of metabolism of certain microorganisms that adversely affect the development and reproduction of other microorganisms. They are one of the greatest discoveries of modern medicine; however, in today's age, the greatest challenge is the resistance of bacteria to antibiotics. There are numerous reasons for the emergence of antibiotic resistance. One reason lies in inadequate education about antibiotics, their application, and usage. The aim of this study was to survey students of the University of Sarajevo's Faculty of Health Sciences about their general knowledge of antibiotics and their methods of application. A total of 151 students participated in this study, including 125 females (83%) and 26 males (17%). The questions consisted of two parts: the first part covered general knowledge about antibiotics, while the second part addressed bacterial resistance to antibiotics.

Antibiotics constitute a group of medications used to treat infections caused by bacteria and their colonization. A casual understanding of the importance of rational antibiotic use results in antimicrobial resistance, leading to the ineffectiveness of the drug when it is most needed. Today, a pressing issue is bacterial resistance to antibiotics, one of the reasons being poor antibiotic management and insufficient knowledge about them. The purpose and objective of this research were to assess the knowledge and use of antibiotics among students of the Faculty of Health Sciences at the University of Sarajevo. This study involved 151 students, including 125 females (83%) and 26 males (17%). The survey comprised questions about general data on the significance and use of antibiotics. The importance of understanding antibiotics and knowing how to use them for specific problems is discussed in Chapter 3. of this scientific research paper.

Adherence is a a term that has been prominently used and emphasized recently, representing the connection between a patient and their treatment. Medical adherence has its hierarchical structure, with roots primarily stemming from legislative bodies to the healthcare system, institutions and ultimately healthcare professionals (doctors, nurses, technicians). However, medical adherence faces a significant obstacle in achieving therapy goals and improving treatment outcomes among many patients, especially those with chronic conditions. Social and sociental conditions, as well as the state organization in Bosnia and Herzegovina (BiH), greatly influence the healthcare system and the purchasing power of healthcare service users. Due to significant barriers and challenges regarding adherence, efforts are being made to maintain a system that supports increasing patient adherence levels. Within this research paper, three questionable theses are presented: internal and external education, improvement of the healthcare system and the implementation of systematic data collection on patient adherence. All three questionable thesis recived positive feedback from respondents (200 participants). From the first thesis, 154 respondents voted in favor, for the second thesis, 142 respondents and for the third thesis, 134 respondents agreed with the proposed suggestions. Unfortunately, in BiH insufficinet attention is given to patient adherence and there is no unified strategy to increase adherence levels. Internal and external education would be essential as healthcare workers are not adequately trained, nor are conditions created for its implementation. Increasing the level of adherence can greatly benefit healthcare workers in their daily practice if they have adequate conditions in place. Unfortunately, a significant number of healthcare employees lack the knowledge, experience and a clearly defined strategy on how to increase patient adherence. The complexity of measuring adherence only adds to the intricacy of an already complex problem and the inefficiency and sluggishness of the healthcare system hinder the creation of appropriate activities that should result in increased patient adherence. The patient’s adhrence is influenced by numerous factors for which there is no unique solution or overcoming suggestions. Also, problems in the process of identifying and measuring adherence further complicate the already complex matter and the process of increasing user adherence. Creating a strategy to improve adhrence at the state level in Bosnia and Herzegovina is almost impossible; therefore, the increase in adhrence can only be achived at the level of the patient, healthcare personnel and ideally, at the level of healthcare institutions. Unfortunately, in most cases, conditions and workload do not allow healthcare workers to spend enough time with patients, establish adequate communication and demonstrate that the patient is genuinely important to them. Providing not only the necessary care but also essential information about the illness and treatment can directly impact the level of patient adhrence. The healthcare system in developed countries, although technologically possible, lacks and adequate mechanism for collecting, processing and analyzing data related to the adherence level of patients with a specific condition or in a particular geographic region. Data is often collected based on indirect methods that do not provide accurate and precise information, posing a significant challenge in proving the role and importance of medical adhrence in the healthcare system and treatment outcomes. Considering that the adhrence level ranges from 43% to 78%, which is too high for certain treatment regimens, legislative reforms are needed. In addition to the law and its govering body, it is necssary to ensure all essential materials, from medications to specific medical supplies are provided to all healthcare institutions, hospitals and healthcare centres. Both internal and external education are crucial for patient treatment and therefore it sholud be implemented and carried out on a monthly basis. In addition to healthcare professionals, the education of patients with medical conditions is essential, considering they can be divided into those who are not familiar with using modern technologies to educate themselves and understand the role and significance of medical adherence. Moreover, there are patients who are adept at using modern tchnology to research their condition and treatment options, but they lack sufficinet knowledge and information to assess the accuracy of the available data.

Aim To evaluate Helicobacter pylori (H. pylori) resistance to clarithromycin and quinolones in patients with dyspepsia in Tuzla Canton, Bosnia and Herzegovina, a region with no data on clarithromycin or quinolones resistance. Methods A prospective cross-sectional study was conducted at the Department of Gastroenterology and Hepatology at University Clinical Centre Tuzla between January 2021 and June 2022. The study included 99 patients who underwent esophagogastroduodenoscopy (EGDS) due to dyspepsia. In all patients biopsies were taken for rapid urease test (RUT) and histology findings, concomitantly with blood samples for IgG serology. All RUT positive patient samples were tested for clarithromycin and quinolones susceptibility with GenoType HelicoDr, a PCR method which detects point mutations in 23S rRNA and mutations in the gyrA gene. Results Out of 99 dyspeptic patients, 67 (67.7%) were serologically positive to H. pylori, 46 (46.4.%) were RUT positive, and 19 (19.2 %) had a positive histology finding. Antibiotic (AB) resistance was tested in the total of 46/99 (46.4%) patients. Resistance to clarithromycin was detected in 28.26% (13/46), quinolones resistance in 36.96% (17/46) , and resistance to both AB was detected in 8.69% (4/46) tested biopsies. Conclusions Due to high clarithromycin and quinolones resistance rates, we recommend the use of bismuth quadruple or non-bismuth concomitant quadruple therapy for H. pylori eradication in Tuzla Canton, Bosnia and Herzegovina.

Portal vein aneurysm (PVA) is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. It can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner. A review from 2015 entitled “Portal vein aneurysm: What to know” considered fewer than 200 cases. In the last seven years, there has been an increase in the number of PVAs diagnosed thanks to routine abdominal imaging. The aim of this review is to provide a comprehensive update of PVA, including aetiology, epidemiology, and clinical assessment, along with an evaluation of advanced multimodal imaging features of aneurysm and management approaches.

Aims: To evaluate the efficacy of metronidazole monotherapy and modified therapy with metronidazole + nifuroxazidefor the for treatment of a mild form of Clostridium difficile infection (CDI). Study Design: A prospective, randomized, controlled clinical trial. Place and Duration of Study: University of Applied Sciences Tuzla in the period from June 2018 to June 2019. Methodology: Sixty patients were included in the study, divided into two groups. One group received standard therapy (metronidazole) for the treatment of a mild form of CDI, while the other group was treated with modified therapy (metronidazole + nifuroxazide). Subjects with a developed clinical picture and a positive toxin test for Clostridium difficile were surveyed on the day of admission, then on the 4th, 10th, 14th and 30th days from the start of therapy. The goal of the research was to determine the impact of the modified therapy protocol on the number of stools and the presence of pain compared to standard therapy. Results: The modified therapy with metronidazole + nifuroxazide showed better pharmacological efficacy in the treatment of CDI compared to the standard therapy with metronidazole alone. The group of subjects who were treated with modified therapy reported a significantly lower number of stools (P=.001) and the absence of pain at the first and second check-ups. Conclusion: Nifuroxazide and metronidazole represent a combination of drugs that reduce the number of stools in the shortest possible time and result in the absence of abdominal pain in patients diagnosed with a mild form of CDI.

A 37-year-old man presented with jaundice, upper right quadrant pain, and intermittent fever with chills. Laboratory assessment showed biliary stasis, with total bilirubin of 203 µmol/L (2–20), conjugated bilirubin of 105 µmol/L, and alkaline phosphatase of 556 U/L (30–120). Markers for hepatitis A–E viruses were negative. Serology assessment for rubeola, herpes simplex virus, Epstein-Barr virus, and Toxoplasma gondii showed negative IgM antibodies. HIV serology status was negative. For cytomegalovirus, both types of antibodies (IgM and IgG) were positive, with an IgM level >300 U/mL. pp65 antigen was also detected as well as CMV DNA. Diagnostic imaging of the abdomen except the dilated common bile duct showed a normal appearance of the gallbladder, liver, pancreas, spleen, and both kidneys. To our knowledge, cytomegalovirus cholangiopathy in the absence of any other underlying disease has not been reported. Therefore, the presence of cholangiopathy in our patient is interesting from an imaging, laboratory, and clinical point of view.

Background Since the beginning of the COVID-19 pandemic, several inflammatory markers have been investigated as possible predictors of survival. Ferritin and from recently LDH have emerged as a possible marker that could serve to this purpose, with different cut-off levels than standard. Furthermore, serum elevations of these markers were reported in other viral infections such as dengue fever; while it has not been reported in MERS and SARS outbreaks and possibly making a biochemical distinction between COVID-19 and other similar diseases. The aim of this research was to establish independent admission levels of ferritin and LDH that predict lethal outcome more accurately. Methods In this prospective cohort study all the patients were hospitalized at UKC, B&H (n=137), between 28th of March and 1st of August 2020. The criteria for hospitalization was based on MEWS score, and all the inflammatory markers were evaluated in the first 72 hours of admission. Cut-off values of serum ferritin levels were set at 1500 ng/mL and LDH 350 U/L. Results Patients with serum ferritin levels >1500 ng/mL had 7.304 OR (CI95% 1.956-27.277; p=0.003) higher for lethal outcome than the group with <1500 ng/mL. Also, patients with levels of LDH >350 U/I had 5.560 (CI95% 2.480-12.468; p<0.001) higher OR of lethal outcome than patients with LDH <350 U/L. With the significant statistical difference between group means for both ferritin and LDH (p<0.001).Discussion Serum levels of ferritin >1500 ng/ml and LDH >350 U/L increase OR of lethal outcome. The levels of these inflammatory markers indicate the degree of inflammatory response and severity of the disaese as well as the possible outcome of the disease. Together these two markers could be used as predictors in clinical settings and treatment planning of patients with COVID-19.Conclusion: Together these two markers could be used as predictors in clinical settings and treatment planning of patients with COVID-19.

difficulties in therapy patient's own temporary stop consuming therapy (43.6%). The importance of high adherence level is presented in a large number of studies, which prove it affects not only the effectiveness of therapy, but also many other segments such as the quality of patient's life, the health system, etc. Measures and proposals for increasing the level of adherence in FBiH health care are mainly based on available research in the world, as well as research carried out in FBiH, and on the basis of other available information in primary and secondary data sources. Due to the numerous limitations and complexities of the state and political ordering, and to the inability to allocate significant financial resources, we consider it a realistic option to increase the level of adherence through measures and proposals that are in the patient / medical personnel domain.

We present here a systemic lupus erythematosus (SLE) related biochemically silent pancreatitis which was assessed via computed tomography in a 35-year-old woman. A patient with a twelve-year history of SLE presented with exacerbation of symptoms of the basic disease, with SLE Disease Activity Index > 15. She was referred to inpatient care. Dosage of corticosteroid and azathioprine for SLE was increased; subclinically and biochemically silent pancreatitis had developed, and was not diagnosed within an appropriate time. On the 15th hospital day, the patient died due to multisystem organ failure, which was defined as a consequence of clinically and biochemically silent pancreatitis in systemic lupus erythematosus.