<p><strong>Introduction.</strong> Conflict is a process during which one person consciously and intentionally makes an effort to prevent the other person&rsquo;s efforts, some kind of blockade that will lead to interruption in achieving the goals and interests of the other person. Conflicts in the healthcare team are common and can lead to reduced productivity in the work of healthcare professionals, which can have a negative impact on the care and treatment of patients. <strong>Methods. </strong>This cross-sectional study involved 100 health professionals, nurses and doctors employed in the primary, secondary and tertiary levels of health care. The research was conducted from March to August 2020. A questionnaire on socio-demographic characteristics of respondents, a questionnaire on conflicts of health professionals, and a standardized scale of depression, anxiety and stress with 21 questions (DASS-21) were used to measure the level of subjective depression, anxiety and stress <strong>Results.</strong> Seventy-four health workers (74%) had experience of conflict in the workplace, doctors (95%) significantly more often than nurses (58%) (p=0.001). Forty percent of health workers stated that communication problems were the most common cause of conflict. Seventy-nine respondents (79%) chose cooperation and compromise as a style in conflict resolution. Doctors chose cooperation more often (84%) than nurses (74%) and the difference was statistically significant (p=0.048). Subjects who had experience of conflict had significantly higher average values of anxiety (8.01&plusmn;2.12) (p=0.026) and stress (10.32&plusmn;2.91) (p=0.008) compared to subjects who had no experience of conflict (6.13&plusmn;1.91; 6.12&plusmn;2.03). <strong>Conclusion.</strong> Doctors were significantly more likely to have conflict situations in the workplace. For conflict resolution doctors were more likely to choose a style of cooperation and compromise than nurses who were more likely to choose a style of conflict avoidance.</p>

Background: The purpose of this study was to compare home and office BP in the adjustment of antihypertensive treatment. Methods: This study was an open, prospective, noninterventional, multicenter clinical trial that occurred between July 2019 and February 2020, in 34 cities in the territory of the Republic of Serbia, which monitored 1581 participants for 6 months. Depending on the used blood pressure monitoring method used, all patients were divided into control (office BP monitoring) and experimental (home BP telemonitoring) groups. We collected anamnestic data and data about systolic blood pressure (SP), in mmHg, diastolic blood pressure (DP), in mmHg, and heart rate (HR), in beats/minute, from all patients. Results: SP values were significantly different at baseline, and at the second, third, and fourth visits between the two tested groups. Home and office BP decreased significantly (p < 0.000) during the 6-month follow-up. We observed a statistically significant influence of the presence of diabetes mellitus and dyslipidemia on the dynamics of differences between SP monitoring values. Conclusions: Our study suggests that novel technologies in BP monitoring can be excellent alternatives for BP assessment in hypertensive patients with other cardiovascular risk factors such as diabetes and dyslipidemia.

Introduction. The human voice is an important characteristic that enables the distinction of human from other living beings. Otherwise, it represents a picture of a person΄s personality, his health, mental and emotional state. The research aims are to determine the voice characteristics of vocal professionals with diagnosed vocal cord nodules by subjective voice assessment and objective voice measurement before and after vocal rehabilitation. Methods. This study has involved 25 examinees, aged 23 to 56. The subjective voice assessment was conducted with the Voice Handicap Index - VHI questionnaire and the objective voice measurement by a computerized laboratory for voice analysis ''Kay Elemetrics''. The obtained data were processed using descriptive and analytical statistics. Results. Before the vocal rehabilitation and the subjective and objective voice measurements, the examinees had greater psychosocial difficulties associated with their voice quality. After two months of vocal rehabilitation, there has been a significant improvement in the voice of all subjects on the VHI scale. A statistically significant and highly statistically significant improvement have been noticed in six out of seven analyzed parameters of vocal A, by the objective measurement of voice. Namely, the obtained values - the percentage of jitter Jitt (%), the percentage of shimmer Shim (%), the relative average perturbation value RAP (%) and the coefficient of fundamental frequency variation - vFo were highly statistically significant (p < 0.01). The VTI - voice turbulence index and the SPI - soft phonation index also improved, the observed difference was statistically significant (p < 0.05), while the observed difference in the FTRI parameter was not statistically significant (p > 0.05). Conclusion. Vocal rehabilitation has influenced the improvement of the voice quality, which means that the results obtained by objective voice measurements were more in accordance with the results of the subjective voice assessment.

Breast cancer is the most commonly occurring malignancy and the leading cause of cancer-related death in women. Triple-negative breast cancer (TNBC) is the most aggressive subtype and is associated with high recurrence rates, high incidence of distant metastases, and poor overall survival. The aim of this study was to investigate the PI3K/PTEN/Akt/mTOR pathway as one of the most frequently deregulated pathways in cancer. We aimed to explore the impact of PI3K and mTOR oncogenes as well as the PTEN tumor suppressor on TNBC clinical behavior, prognosis, and multidrug resistance (MDR), using immunohistochemistry and copy number analysis by quantitative real-time PCR. Our results revealed that loss of PTEN and high expression of PI3K and mTOR proteins are associated with poor outcome of TNBC patients. PTEN deletions appeared as a major cause of reduced or absent PTEN expression in TNBC. Importantly, homozygous deletions of PTEN (and not hemizygous deletions) are a potential molecular marker of metastasis formation and good predictors of TNBC outcome. In conclusion, we believe that concurrent examination of PTEN/PI3K/mTOR protein expression may be more useful in predicting TNBC clinical course than the analysis of single protein expression. Specifically, our results showed that PTEN-reduced/PI3K-high/mTOR-high expression constitutes a ‘high risk’ profile of TNBC.

Introduction. Inhalation of coal dust during blasting in brown coal mines has been shown to lead to a lung disease called pneumoconiosis. There is very little data in the literature on the direct impact of coal on the quality of life of people who work in coal mines as well as the body's immune response to the effects of coal dust. The aim was to examine the immune response to exposure to coal dust in miners in a brown coal mine and whether mine workers have poorer quality of life compared to those not exposed to coal dust. Methods. This is a cross-sectional study among 100 employees in the Brown Coal Mine in Ugljevik, of which 50 of them are exposed to coal dust on a daily basis. Blood samples were taken from all subjects to test for the presence of cytokines IL-2, 4, 5, 9, 10, 13, 17A, 17F, 21, 22, IFN-g and TNF-a. The quality of life of employees was measured using a questionnaire for self-assessment of physical and mental health (36-item Short-Form Health Survey, SF-36). Results. Group of miners had a significantly (p<0.05) higher concentrations of pro-inflammatory cytokines IL-6, IFN-g, IL-17A and IL-22 when compared to the control group. Subjects from the control group had significantly (p<0.05) higher concentrations of anti-inflammatory cytokines IL-4 and IL-10 when compared to the group of miners. The quality of life was significantly (p<0.05) better in the control group when compared to the group of miners. Conclusion. Physical functioning, general health, mental health and Physical component summary were significantly poorer in the group of miners. Exposition to coal dust led to a significant increase in the production of pro-inflammatory cytokines and a decrease in the production of anti-inflammatory cytokines.

Background/Aim: Orthostatic hypotension (OH) is considered to be a drop in the systolic and diastolic blood pressure (> 20 mmHg; > 10 mmHg) 3 minutes from postural changes. The objective of this study was to analyse the correlation of body mass index (BMI) and OH during the treatment with trandolapril, as a single-drug treatment of hypertension. Methods: The study involved 255 patients (average age 54.3 ± 11.7; 54.1 % men) with poorly regulated hypertension, who were given trandolapril as a single-drug treatment. The patients were divided into two groups regarding stage of hypertension: first-degree arterial hypertension (140-149 mmHg for systolic and 90-109 mmHg for diastolic blood pressure) and second-degree arterial hypertension (> 150 for systolic and > 110 mmHg for diastolic blood pressure). Incidence of OH occurrence was then analysed regarding hypertension stage and BMI during 6 months of follow-up, on 4 control examinations. Results: During 24-week period after trandolapril introduction into the treatment of hypertension, a statistically significant difference in systolic, diastolic and mean blood pressure values was observed. No statistically significant difference was observed in incidence of OH between the first and second as well as between third and fourth examination during the study. Regarding the incidence of OH in normal body weight and obese patients, there was also no statistically significant difference. Conclusion: As shown in this study, trandolapril, along with some other ACE inhibitors, has shown good balance in hypertension control and OH occurrence.

The vascular approach is a prerequisite for performing hemodialysis, but their "weak points" are different and frequent complications. Modern guidelines recommend native arteriovenous fistula (AVF) as the first choice of vascular approach because it is characterized by the longest survival and the least complications compared to other vascular approaches. All complications of AVF can be divided into intraoperative, early, and late postoperative. This paper presents the late postoperative complications of AVF, their frequency, causes, diagnosis and treatment. The most important late postoperative complications are: stenosis, thrombosis, aneurysm or pseudoaneurysm formation, infection, hand edema, hematoma, ischemic steal syndrome, ischemic neuropathy, congestive heart failure. Large differences in the frequency of each complication in earlier studies can be explained by differences in surgical technique, localization of AVF, diagnostic methods, but, above all, differences between the presented groups of patients. It is described that the age of patients, sex, underlying disease, the presence of comorbid conditions and various metabolic and immune disorders characteristic of chronic renal failure, as well as the way of using and caring for AVF significantly affect the occurrence of AVF complications. One of the main predictors of AVF success and survival is the quality of the patients' blood vessels, and therefore careful examination of blood vessels before approaching AVF creation is of particular importance. The creation, use and care of AVF is the task of the team of health professionals who take part in the treatment of these patients, and successful treatment requires their good cooperation, as well as cooperation with patients.

Pneumoconiosis of workers in brown coal mines is an occupational disease, a global public health problem and a serious disease of the lung parenchyma. If it is not prevented, it leads to irreversible changes in the lungs with complications. The disorder occurs after prolonged exposure to coal dust containing high concentration of free crystalline silica. Data in literature regarding its health impact on people working in coal mines are relatively scarce. Recently, there has been an increase in miners’ pneumoconiosis, which requires a stricter policy to protect workers in the mines. There are two classical types of CWP: simple and complicated. The main diagnostic method of CWP is based on a specific X-ray finding, and the auxiliary method of choice is spirometry. The pathophysiological mechanism of CWP formation is not fully known, although it has been shown that damage to the lung parenchyma goes through three phases caused by effect of lung cells exposure to coal dust. Studies show that cytokines play an important role in inflammation and the immune response as mediators of toxic and pathogenic effects in CWP. A link between exposure to coal dust in brown coal mines and the development of CWP has also been demonstrated, with a consequent reduction in the physical and psychological quality of life of workers in the mines.

Introduction. Lower leg fractures are most frequent of all fractures of long bones because a lower leg is very exposed part of a leg, especially it is anteromedial side of tibia, located immediately under skin. Aim of this paper is to analyse results of teatment of open and closed diaphysial tibial fractures using method of external fixation. Patients and methods. We analyzed the results of treatment of open and closed diaphysial tibial fractures using method of external fixation at Department of Ortopedics od Doboj hospital in period from 2005 until 2009. All patients with open fractures been treated first with surgical treatment of the wound up to 8 hours and with installation of external fixator. Patients with closed fractures which did not have satisfactory reposition have been installed external fixator which was worn from 4 to 8 weeks and then taken off, they have been applied a closed lower leg walking cast which was worn pending fracture healing verified by a clinical and xray examination. Patients in wich there was no healing process have undergone a subseqent surgical treatment which in all cases was positive. After surgical treatment all patients were sent for physical therapy. Results. Out of 124 patients with diaphysial tibial fractures, 56 (45,2%) were with open fractures and 68 of them (54,8%) were with closed fractures. After a primary treatment, there were 49 (87,5%) open fractures and 39 (57,4%) closed fractures with complications. Conclusion. Treatment of closed and open diaphysial tibial fractures by means of external fixation in open fractures as standard and selected closed fractures have shown good results with a small number of complications which were removed by a second surgical teatment. This method of treatment fractures is recommendable method in a primary as well as in final treatment of these fractures due to a positive treatment outcome.

Aim: The puspose of this study was to evaluate the incidence of recurrent laryngeal nerve palsy (RLNP) and hypoparathyroidism as most common complications associated with thyroid surgery in relation to the extent of the surgical procedure. Patients and Methods: Postoperative data from 426 patients was collected at the Clinical Institute of Nuclear Medicine and Radiation Protection of the Clinical Hospital Centre Osijek. The patients were operated on the Clinic for Otorhinolaryngology and Head and Neck Surgery and Clinical Department of Thoracic Surgery, Department of Surgery, in the period from 2007 to 2009. Postoperative complications after total thyoidectomy with or without neck dissection, near-total and subtotal thyroidectomy and lobectomy with or without isthmectomy were analyzed with multivariate logistic regression. Results: Patient were aged 52±14.9 years (mean±SD), 365 of them female and 61 male (female:male, 5.98:1). Transient RLNP occurred in 19 cases (4.5%) and permanent RLNP in 13 cases (3%). Transient hypoparathyroidism occurred in almost 4% of cases and permanent hypoparathyroidism in 1.4%. The extent of the operative procedure is not significantly associated with the risk for transient or permanent RLNP. In comparison with lobectomy, subtotal/near-total thyroidectomy, but not total thyroidectomy, is associated with a higher risk for RLNP (OR=2.84). Total and subtotal/near-total thyroidectomy carry a higher risk for hypoparathyroidism in relation to lobectomy. Age and gender are no risk factors for postoperative complications. Conclusion: Complications to thyroid surgery are not uncommon. Total thyroidectomy is a good surgical treatment for some thyroid diseases like cancer or severe hyperfunction due to the risk for disease relapse and possible complications of following reoperation.

BACKGROUND Kidney size may differ between healthy members of Balkan endemic nephropathy (BEN) and non-BEN families. The present study was designed to elucidate this, in comparison with values for BEN patients. METHODS A total of 71 BEN patients (34 males, 64.4 ± 12.0 years), 74 healthy BEN family members (39 males, 49.1 ± 12.2 years), and 59 non-BEN family members (19 males, 49.2 ± 12.3 years) were involved. We measured the longest craniocaudal length and minimal parenchymal thickness on each kidney of all examined subjects using ultrasound. RESULTS No significant difference was found between the kidney length of healthy subjects from BEN (11.0 ± 0.8 cm) and non-BEN families (10.9 ± 0.8 cm), but kidneys were significantly longer than in BEN patients (9.9 ± 1.3 cm). Minimal parenchymal thickness was similar in all three groups. When subjects from each group were divided according to estimated glomerular filtration rate (eGFR), kidney length of the healthy groups was significantly longer than in BEN patients both in stage 1 (p =0.039) and stage 2 (p =0.044) of chronic kidney disease. The parental history of BEN was not associated with kidney dimensions, eGFR, or urinary excretion of albumin and alpha1-microglobulin. CONCLUSION Kidneys of BEN patients were significantly shorter than in healthy members of both BEN and non-BEN families, but no difference was found in kidney length and parenchymal thickness between healthy members of BEN and non-BEN families. No significant association was found between parental history of BEN and kidney size and function either in BEN patients or in healthy members from BEN families. Hippokratia 2015; 19 (4): 304-308.

Introduction: Omphalocele and gastroschisis are developmental defects of the anterior abdominal wall, which have only recently been categorized as separate entities. In both cases, it is a herniation of abdominal organs through appropriate defects of the anterior abdominal wall. It is considered that the omphalocele are quite often developmental anomalies and are often associated with other developmental disorders, unlike gastroschisis, which usually occur isolated. Aims of the study: To determine the frequency of cases of omphalocele and gastroschisis in the Clinical Center of Banja Luka in the period from 2000 to 2013. Patients and methods: Insight into medical records, a retrospective analysis of all cases of congenital defects of the anterior abdominal wall at the Clinical Center of Banja Luka was done from the year 2000-2013. The analysis included all cases of omphalocele and gastroschisis, and prematurity, associated anomalies, the rate of mortality in the first year, exposure to environmental factors during pregnancy, maternal diabetes, maternal age, and familiar occurence of these anomalies were taken into consideration. Cases of „the prune belly“ syndrome and umbilical hernia were not included in this research. Results: During the period 2000-2013, there was a total of 19 cases of omphalocele, of which eigth live births. In the same period there was 14 cases of gastroschisis, and there was seven children born alive with this defect. In 73 percent of omphalocele cases there was associated anomalies, while this rate at gastroschisis was significantly lower and amounted to 28 percent. Among the live births, prematurity rate was 37.5 percent for the omphalocele group and 57 percent for the group of gastroschisis. The mortality rate in the first year of life was 25 percent for omphalocele and 14 percent for gastroshisis. In all these cases, the cause of death was not directly related to abdominal defect, but the associated complications (respiratory distress in the first place). Half of the mothers from both groups stated that they had used some medicines or consumed cigarettes during pregnancy. There was also a single incident of gestational diabetes in the group of omphalocele and one case of a positive family history from the gastroschisis group. Discussion: In this study, the relation of omphalocele and gastroshisis was 19/14 or 1.3:1, compared to the expected 3:2 ratio in the world literature. Other studies around the world show a higher incidence of gastroschisis and lower incidence of omphalocele. We had no reported cases of stillbirths in omphalocele group although, in the world literature, data of 11-12 percent were noticed . The reason for this discrepancy could be a different criteria for stillbirth compared to abortion, and perhaps the reporting was biased. The percentage of associated anomalies was higher in group of omphalocele, and similar results were reported in other studies. The mortality rate in thefirst year of life in a group of omphalocele was much higher when compared to gastroschisis group. For unknown reasons, stillborn children with omphalocele were not represented in this study. 56 Scripta Medica Vol. 46 • No 1 • April 2015. • www.scriptamedica.com