Background: Acute nasopharyngitis is often treated with hypertonic saline that can be combined with additional compounds, such as lysozyme. The aim of this study was to compare efficacy and safety of hypertonic saline solution with or without lysozyme in the treatment of acute nasopharyngitis. Methods: Non-interventional, prospective, multicentre, observational, parallel study was conducted on adult subjects with symptoms of acute nasopharyngitis. Subjects were divided into hypertonic saline or lysozyme group (receiving slightly hypertonic nasal spray with addition of lysozyme). Time until the patency of both nasal passages was measured after the first application of therapy. The congestion severity was assessed by using a visual analogue scale before the therapy application, after 30 minutes, and after seven days. Adverse reactions were monitored and evaluated.   Results: The total number of included subjects was 252 (60 in the hypertonic saline group and 192 in the lysozyme group). In both groups, a significantly better assessment of the severity of the nasal passages’ obstruction was recorded after 30 minutes and seven days from therapy start (for all compared time intervals p<0.001). The lysozyme group had a significantly lower nasal congestion score compared to hypertonic saline 30 minutes after therapy (p<0.001) and seven days from the therapy start (p=0.001). In the hypertonic saline group, a significantly shorter time was observed to establish the patency of the nasal passages after the first therapy application (p<0.001). All adverse events were mild. Conclusions: Addition of lysozyme to slightly hypertonic nasal spray brings added value in the pharmacotherapy of acute nasopharyngitis.

Introduction. The development of the coronavirus disease 2019 (COVID-19) vaccine marked the beginning of the end of the pandemic and the understanding of the disease as something that is part of clinical practice. The aim of this study was to investigate, assess, and demonstrate the signifi cance of vaccination on the outcome of severely ill patients treated in intensive care units. Methods. A retrospective study was conducted on a sample of patients hospitalized at the Clinic for Infectious Diseases of the Clinical Center of the University of Sarajevo during 2022. Results. Participants who were vaccinated against COVID-19 had a lower mortality rate and a higher chance of survival compared to unvaccinated participants. Additionally, disease outcomes were signifi cantly infl uenced by oxygen saturation and platelet count at admission. Conclusion. COVID-19 vaccination signifi cantly reduced the mortality rate, with vaccinated par-ticipants having a higher chance of survival compared to unvaccinated participants.

During the COVID pandemic, research has shown an increase in candidemia cases following severe COVID infection and the identification of risk factors associated with candidemia. However, there is a lack of studies that specifically explore clinical outcomes and mortality rates related to candidemia after COVID infection.

Background: Autoimmune limbic encephalitis (ALE) is an inflammatory brain process involving a group of diseases with antibodies against neuronal synaptic and cellular antigens. Diagnosis is based on clinical examination, neurological functional tests, cerebrospinal fluid analysis, immunological testing, and radiological findings. Objective: This case report aims to present the case of a 68-year-old patient initially hospitalized for intermittent neurological deficits in the form of cognitive disorders of consciousness, which was initially declared as dementia without physical neurological deficit. Case presentation: Initial brain MRI (SIEMENS Magnetom Avanto, 1.5 T, Erlangen, Germany) showed changes differentially diagnosed characterised as glial neoplasm of mixed-grade astrocytoma or inflammatory process of unilateral autoimmune encephalitis. Since the neurosurgical opinion suggested a higher-grade glioma with proposed surgical treatment, the patient was referred for repeated MRI with MR spectroscopy in order to exhaust all diagnostic possibilities before surgery. MRI with MR spectroscopy (SIEMENS Magnetom Lumina, 3 T, Erlangen, Germany) revealed radiologically altered findings, in the right hippocampus and parahippocampal gyrus, which primarily corresponded to changes due to unilateral autoimmune encephalitis,due to its morphology characteristics and spectroscopy profile, making the primary glial neoplasm of lower grade less likely. Since the neurological mosaic IIFT result showed a positive LGI1 antibody finding, therapy for autoimmune encephalitis was initiated, leading to significant improvement in cognitive functions and the return of short-term memory. Conclusion: Although the detection of antibodies against onconeural, cellular, and synaptic proteins represents a significant advancement in diagnosing autoimmune limbic encephalitis, the role of conventional diagnostic tools such as MRI, EEG, and cerebrospinal fluid analysis should not be overlooked, where the application of new functional imaging techniques such as MR spectroscopy can be beneficial and should be considered.

Introduction: Heart failure (HF) still remains as one of the most common causes of hospital admission with a high mortality rate. Aim: To investigate the possible prognostic role of brain natriuretic peptide (BNP), high-sensitivity (hs) cardiac troponin (cTn) I, cystatin C, and cancer antigen 125 (CA125) in the prediction of decompensation after an index hospitalization and to investigate their possible additive prognostic value. Patients and Methods: Two hundred twenty-two patients hospitalized with acute HF were monitored and followed for 18 months. Results: BNP at discharge has the highest sensitivity and specificity in the prediction of decompensation. For a cutoff value of 423.3 pg/ml, sensitivity was 64.3% and specificity was 64.5%, with a positive predictive value of 71.6% and an area under the curve (AUC) of 0.69 (P < 0.001). The hazard risk (HR) for decompensation when the discharge BNP was above the cutoff value was 2.18. Cystatin C, at a cutoff value of 1.46 mg/L, had a sensitivity of 57% and specificity of 57.8%, with a positive predictive value of 65.8% and an AUC of 0.59 (P = 0.028). CA125, in the prediction of decompensation in patients with acute heart failure (AHF) and at a cutoff value of 80.5 IU/L, had a sensitivity of 60.5% and specificity of 53.3%, with a positive predictive value of 64.5% and an AUC of 0.59 (P = 0.022). The time till onset of decompensation was significantly shorter in patients with four versus three elevated biomarkers (P = 0.047), with five versus three elevated biomarkers (P = 0.026), and in patients with four versus two elevated biomarkers (P = 0.026). The HR for decompensation in patients with five positive biomarkers was 3.7 (P = 0.001) and in patients with four positive biomarkers was 2.5 (P = 0.014), compared to patients who had fewer positive biomarkers. Conclusion: BNP, cystatin C, and CA125 are predictors of decompensation, and their combined usage leads to better prediction of new decompensation.

Introduction. Bosnia and Herzegovina (B and H) has been recognized for decades as a country with a high risk of diseases caused by hantaviruses.Gap statement. The severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) pandemic has diverted attention from many pathogens, including hantavirus.Aim. To provide a socio-demographic, temporal, geographical and clinical laboratory overview of the expansion of hantavirus infection cases during the SARS-CoV-2 pandemic in B and H in 2021.Methodology. The RecomLine HantaPlus IgG, IgM immuno-line assay (Mikrogen, Germany) was used to detect IgG and IgM antibodies to hantavirus serotypes in human sera from clinically suspected cases.Results. In 2021 (January-October), the number of confirmed cases of hantavirus infection and tested persons (92/140; 65,71 %) was higher than in the previous 2 years, 2020 (2/20; 10.00 %) and 2019 (10/61; 16.39 %). Most of the infected persons were men (84/92; 91.30 %). Hantavirus infections were recorded from January to October 2021, and the peak was reached in July (25/92; 27.17 %). Six out of 10 cantons in the Federation of Bosnia and Herzegovina (FB and H) were affected, namely Sarajevo Canton, Central Bosnia Canton, Neretva Canton, Zenica-Doboj Canton, Posavina Canton and Bosnian-Podrinje Canton Goražde, in descending order. Of the 38/92 (41.30 %) infected patients with characteristic clinical manifestations of haemorrhagic fever, including renal (mainly) or pulmonary syndrome, 32/92 (34.78 %) were hospitalized in the Clinical Center of the University of Sarajevo. Two cases were detected with dual infection, hantavirus (Puumala) with Leptospira in one and SARS-CoV-2 in another case. The largest number of infections was related to Puumala (PUUV) (83/92; 90.22 %), while the rest of the infections were caused by the hantavirus Dobrava serotype (DOBV).Conclusion. The reported infections were probably caused by exposure of individuals to at-risk areas inhabited by contaminated rodents as natural reservoirs of hantavirus. As a highly endemic area, B and H requires continuous monitoring and increased awareness of this problem.

Background: The lumbar spinal canal consists of 5 interconnected lumbar vertebrae through which the final part of the spinal cord passes and the lumbar and sacral spinal nerves that form the cauda equina. The lumbar canal stenosis can directly affect neurological symptoms and pain in the lumbar region and lower extremities. Due to the frequency of such symptoms, lumbar stenosis has been the subject of research around the world. Objective: The objective of this study was to measure, analyze and compare the mediosagital and interpeduncular diameters of the lumbar spinal canal in the population of Bosnia and Herzegovina to other populations around the world. Methods: We conducted a retrospective descriptive study on patients (n=200) who underwent Multi-slice computer tomography (MSCT) performed on a 40-slice CT scanner (Siemens Somatom Definition AS) for lumbar pain between January 1, 2013 and December 31, 2014. Age, gender, midsagittal (MSG) and interpeduncular (IP) diameters of the lumbar spine were recorded for each patient. Results: Results of our study show that the largest MSG diameter is at L1 level for both sexes, with an average length of 19,06mm, and the smallest at L3 level, with an average length of 16,66mm. Our study shows that the MSG diameter is significantly larger in females than males on all levels from L1 to L5. In both sexes, MSG diameter shows the form of an hourglass with narrowing at L3 level. IPD is largest at L5 level for both sexes, with an average length of 31,94mm, and the smallest average length at L1 level, at 24,78mm. IPD diameter is significantly larger in males than females on all levels from L1 to L5. IPD shows a tendency of growth from L1 to L5 in both sexes. Conclusion: There were significant differences in the dimensions of the lumbar spine canal between female and male patients. We found significant difference in MSG and IP diameters measurements between Bosnian and Herzegovinian population compared to other populations. The dimensions of the lumbar canal provide a baseline of normative data for the evaluation of patients presenting with lower back pain and lumbar canal stenosis in study population.

Aim The aim of this study was to link the values of D-dimer and C-reactive protein (CRP), with the occurrence of pericardial effusion in patients who had coronavirus disease 2019 (COVID-19) and have preserved systolic function of the left ventricle (LV). Methods This was a prospective study and included 146 patients who underwent echocardiographic examination 30 days after the acute phase of COVID-19. Patients who were placed on mechanical ventilation, patients who had pulmonary thromboembolism or acute coronary syndrome during the acute period of the disease, patients who had an ejection fraction of the LV <50%, patients who were diagnosed with pericarditis during acute illness or clinical signs of heart failure (or had elevated N-terminal-pro hormone B-type natriuretic peptide value), with verified renal or hepatic dysfunction were excluded from the study, including patients with diabetes mellitus Type 1, patients with cancer, connective tissue disease, or pregnant women. The existence of cardiovascular risk factors (hypertension, diabetes mellitus Type 2, and hyperlipidemia), the presence of previous ischemic heart disease, maximum values of D-dimer, and CRP (during the first 15 days of the disease) was taken into the analysis. Results Effusion was verified around the right atrium (RA) in 104 patients (3.85 ± 1.75 mm), in 135 patients next to the free wall of the right ventricle (RV) (5.24 ± 2.29 mm), in front of the apex of the LV in 27 patients (2.44 ± 0.97 mm), next to the lateral wall of LV in 35 patients (4.43 ± 3.21 mm), and behind the posterior wall of LV in 30 patients (2.83 ± 1.62 mm). Mean CRP values during the acute phase of the disease were 43.0 mg/L (8.6–76.2 mg/L), whereas D-dimer mean value was 880.00 μg/L (467.00 –2000.00 μg/L). CRP values correlated with effusion next to the free wall of RV (rho = 0.202; P = 0.018). The D dimer correlated with effusion around RA (rho = 0.308; P = 0.0001). Conclusion The clinical picture of the post-COVID patients could be explained by the appearance of pericardial effusion. D-dimer value correlates with the occurrence of effusion around RA, whereas CRP value correlates with effusion next to the free wall of RV.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) whose pandemic was declared on March 11 2021 (1). Spectrum of COVID-19 clinical manifestations is very wide. Most patients report to ambulance with mild or moderate symptoms, but some of them rapidly develops acute respiratory distress syndrome (ARDS), respiratory failure, acute cardiac injury, multiple organ failure and death (2). Older age, diabetes mellitus and cardiovascular disease are reported as high predictors of morbidity and mortality. Aim: To determine correlation between diabetes mellitus and severity of clinical picture in patients with COVID-19. Methods: Current study involve retrospective analysis of 1513 patients with Real Time PCR confirmed COVID-19 hospitalized in Clinic for infectious disease, University Clinical Center, Sarajevo, Bosnia and Herzegovina, in a period of June 2020 to December 2020. Results: Among them 417 had previously diagnosed of diabetes mellitus. Results show that patients with diabetes mellitus are likely to require treatment in Intensive care unit, and oxygenic support with invasive ventilation. There was no statistically significant difference in outcome of the disease. Conclusion: Even this study didn’t find increased mortality in patients with COVID-19 and diabetes mellitus, further studies should be done to determine risk for patients with DM to develop severe form of disease.                   Peer Review History: Received 23 March 2021; Revised 17 April; Accepted  5 May, Available online 15 May 2021 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency.  Received file:      Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewer(s) detail: Dr. Branislav Rankovic, University of Kragujevac, Serbia, rankovic@kg.ac.rs Dr. Poualeu  Kamani  Sylviane  Laure, University of Dschang, Cameroon, poualeusylviane@yahoo.fr Similar Articles: THE RISKS AND ADVANTAGES OF ANTI-DIABETES THERAPY IN THE POSITIVE COVID-19 PATIENT

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries ( P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.

Introduction: Electroencephalography can also be used to monitor long-term recovery of the patient after acute phase of the disease. Impaired neurocognitive function after infection, similar to brain injury, may present a transient but also prolonged problem for the functioning of an individual. Some studies have shown that importance of EEG may not be significant in sequel monitoring, because the extensive changes in EEG seen with severe forms of CNS infection do not necessarily imply a longer-term poor outcome. Aim: To examine the predictive potential of electroencephalography (EEG) in regard to the emergence of neurological and cognitive sequelae of acute central nervous system (CNS) infection. Methods: The study included 62 patients treated at the Clinic for Infectious Diseases, Clinical Center of Sarajevo University, who were diagnosed with acute CNS infection. The EEG record was characterized as: normal, non-specific changes of mild, moderate and severe degree and specific changes. The sequelae (headache, cognitive dysfunction, neurological and neurophysiological disorders, audiological and behavioral disorders) was evaluated by combining neurological, psychiatric, pediatric, otolaryngological, ophthalmic and infectological examination in the Neuroinfective Counseling Department for up to 6 months after discharge. Results: After a treatment of an acute CNS infection 25 (40.3%) patients had no sequelae and 37 (59.7%) were with sequelae. The EEG in the initial stage of the disease (Wald’s coefficient = 12.8), followed by the age of the patients (Wald = 6.4), had the greatest influence on the prediction of sequela (p=0.0001). For each additional degree of verified pathological changes in the EEG, the risk of sequelae was increased by 5 degrees (OR = 5.3), respectively. There was no statistically significant association between changes in cerebrospinal fluid (CSF) findings, meningeal symptoms, and signs with sequelae development. Conclusion: Younger age, as well as severe clinical status of a patient, which implies a disorder of consciousness and seizures on admission, are associated with irreversible consequences on a previously mentally healthy individual. Pathological changes (Delta and Theta waves, spike slow complex wave) on the EEG finding significantly predicted presence of sequelae. .

Bites of laboratory animals are treated as the bites of any other animals since the possibility of existence of pathogenic microorganisms, unfavorable for human health, in the rooms where these animals reside, is not excluded. A rare case of a laboratory rat bite, used for scientific research and previously infected with Pseudomonas aeruginosa , is presented here. The patient's wound was located on the forefinger of his hand and was 1 cm long and up to 0.2 cm deep. The antitetanus prophylaxis was administered in an ambulance, including antibiotic therapy with amoxicillin-clavulanate per os. There exists a need for checks and special guidelines for the handling and retention of laboratory animals. The patient has successfully remedied the wound, thanks to consistent antibiotic therapy and antitetanus prophylaxis, and possible inflammatory complications were prevented .