1University Clinical Centre Sarajevo, Clinic for Infectious Diseases, Sarajevo, Bosnia and Herzegovina 2University Clinical Centre Sarajevo, Department of Immunology, Sarajevo, Bosnia and Herzegovina 3University Clinical Centre Sarajevo, Department of Clinical Biochemistry, Sarajevo, Bosnia and Herzegovina 4University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Infectious Diseases

Background: This cost-of-illness (COI) study provides deep insight in direct and indirect costs of multiple sclerosis (MS) in Bosnia and Herzegovina (BH). Aim: Objective of this study was to analyze the costs and quality of life (QoL) of patients with MS in BH. Patients and methods: We applied the same methodology already used in study conducted across nine European countries. Sixty-two patients participated with EDSS score not higher than 6.5. Costs are collected using a questionnaire quality of life was measured by EQ-5D and MSQOL-54 questionnaires. Results: Mean age of respondents was 39.8 The mean utility measured by EQ-5D-3L was 0.68 at the beginning and 0.63 at the end of the study. QoL measured by MSQoL-54 showed improvement at the end of the trial. Costs are presented from the societal and payer perspective. Cost of MS in Bosnia and Herzegovina annually amount 124.8 million BAM. Cost driver where indirect and DMDs costs, with significant differences among subgroups. Conclusions: This study provides an in-depth analysis of MS costs in BH providing data for health policies development and information for future cost-effectiveness evaluations of new therapeutic options as well as for comparison of MS costs with other countries.

Introduction: A tricuspid annular plane systolic excursion (TAPSE) reflects longitudinal myocardial shortening and represents an echocardio­graphic parameter to assess right ventricular systolic function.Aim: To determine relationship between TAPSE and gestational age and body weight in neonates, establishing method for prediction the normal TAPSE values in neonates based on gestational age and body weight.Patients and methods: The prospective study group consisted of 97 neonates from 24 to 40 weeks of gestation, with a weight of 625-4,340 g and normal echocardiographic results with determination of TAPSE based on gestational age and body weight.Results: The TAPSE range was 6.45-9.80 mm (with average value 8.07 ± 1.89 mm) in male and 6.95-8.50 mm (with average value 7.9 ± 1.86 mm) in female babies, depending on gestational age. There was no statistically significant difference of normal TAPSE values between female and male patients (p = 0.586). TAPSE is affected by increasing birth weight and increasing gestational age. The TAPSE values have had strong and positive correlation with gestational age (p = 0.0001, rho = 0.692) as well with body weight (p = 0.0001, rho = 0.786). Regression equation relating body weight and TAPSE is: TAPSE predicted = 4.738 + (body weight * 0.002); equation relating gestational age and TAPSE is: TAPSE predicted = -4.163 + (gestational weeks * 0.385).Conclusions: It is possible to adequately predict TAPSE based on gestational age. As TAPSE is easy to measure and highly reproducible, we consider it a useful quantitative parameter to assess right ventricular longitudinal function in premature baby.

Abstract Granulysin is a recently discovered cytolytic protein of natural killer (NK) cells and cytotoxic T lymphocytes. Studies of healthy and immunocompromised patients with primary or recurrent varicella-zoster infections demonstrate the importance of virus-specific cellular immunity in controlling viral replication, but also some studies presented granulysin as a molecule that can play a role in chickenpox immunopathogenesis. This study investigated possible correlation between serum granulysin levels and clinical course of chickenpox. A total of 69 patients with chickenpox were included in the study. We measured the levels of granulysin and percentage count for CD4+, CD8+ and NK cells in serum for all patients and healthy controls. For detection and quantification of granulysin in sera, we performed ELISA test and flow cytometry for detection, identification and percentage measurement of T and B lymphocytes. Descriptive methods, analysis of variance and multivariate logistic regression were used for statistical data analysis. We found respective correlation between serum granulysin level and severity of clinical presentation. These findings can be a good input for further studies, since there is no relevant prognostic parameter of chickenpox in everyday clinical practice. Granulysin, as a therapeutic, also deserves to be a point of interests in the future. If we prove its potential to stop dissemination of human herpes viruses, possibilities to use it in some life-threatening forms of viral disease can be very valuable.

Introduction: Quality of life in patients with acute pharyngitis or tonsillitis is significantly lower than in healthy persons, and it should be taken into account when efficacy of new therapeutic options is investigated. Objective: The aim of this study was to develop and validate a reliable instrument that can measure quality of life in adult outpatients with sore throat caused by acute pharyngitis or acute tonsillitis. Method: The study was of a cross-sectional type, and assessed reliability and validity of newly developed questionnaire for measurement of quality of life in adult outpatients with sore throat (STQoL) caused by acute pharyngitis or acute tonsillitis. It was conducted on a sample of 282 patients, with mean age 39.0 ± 14.8 years, male/female ratio 104/178 (36.9%/63.1%). Results: Final version of the STQoL scale with 21 items showed excellent reliability, with Cronbach’s alpha 0.949. It was temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains, Social/psychic aspects, Physical aspects and Environmental aspects of sore throat related quality of life. Conclusions: The STQoL scale is reliable and valid specific instrument for measuring sore throat related quality of life, which is an important treatment outcome in patients with acute pharyngitis or tonsillitis.

Introduction: The prevalence of allergic asthma are increasing, and the clinical outcome and risk factors of immunotherapy in the treatment of allergy have not been well established. Especially, the impact of viral infection on cytokines in allergic inflammation has yet to be established. This study aimed to determine serum IL-3, IL-11 and IgE levels and blood eosinophil and neutrophil counts during a one-year follow up in patients with allergic asthma on immunotherapy and those on anti-asthmatic drugs only, in the presence of influenza-like illness.

Introduction: The purpose of this study was to validate Bosnian translation of disease specific quality of life measure MSQoL-54 which is widely used in practice. Material and Methods: Previously translated and culturally adopted MSQoL-54 questionnaire used in this study has been provided and licensed by Optum Inc. The questionnaire was validated in 62 MS patients seen at Neurology clinic at University Clinical Center Sarajevo, during April 2016 until May 2016. Internal reliabilities of Bosnian version MSQoL-54 were assessed for multiple item scales by using Cronbach’s alpha coefficient. Clinical validity was assessed comparing means of the two summary MSQoL-54 scores by the EDSS score. Pearson’s (r) correlation coefficient was used to investigate the relationship between the composite scores and the main clinical and demographic variables. Results: Patients’ participation was satisfactory and all scales fulfilled the usual psychometric standards. Highly significant inverse relationship was found between both composite scores and clinical characteristics of the disease and the EDSS. The lowest internal consistency reliability is found on social function scale (0.743), overall quality of life (0.782) and pain (0.833). The highest internal consistency reliability is found on role limitations due to physical problems (0.959), physical health (0.962) and role limitations due to emotional problems (0.966). The mean value of MSQoL-54 PHC (Physical Health Composite) and MHC (Mental Health Composite) were 49.82±18.90 (36.05-61.38) 51.84±22.22 (34.93-70.20) respectively. Our study has shown that the Bosnian version of MSQoL-54 is easy to administer and well accepted by patients and may be useful as clinical outcome measures in patients with MS.

Objective: Morphological differences between sexes are also reflected in the skull bones, which can be used for sex determination of skulls. Our objectives were to observe the osteoscopic features of skulls and determine the frequency of characteristic female features in female skulls and the frequency of characteristic male features in male skulls in the observed sample; also to determine the prediction (effectiveness) of sex determination based on observed morphognostic (osteoscopic) features of the skulls and determine the most frequent and the least frequent morphognostic feature both in male and in female skulls in our tested sample. Methods and materials: The research was conducted on a sample of 211 macerated and degreased adult skulls (139 were male skulls and 72 were female skulls). Qualitative (osteoscopic) analysis included observation of the following: prominence of frontal tuber; prominence of superciliary arch and glabella; appearance of supraorbital margin; appearance of orbit; width of root of nose; prominence of mastoid process; contours of muscle insertions; size of teeth and face shape.         Results: Univariately, all ten observed morphognostic skull features showed statistically significant effect on sex determination, while prominence of superciliary arch and glabella proved to be the best morphognostic features with 90% accuracy, followed by prominence of muscle insertions with 82% accuracy, and prominence of mastoid process with 75% accuracy. Using multivariate binary logistic regression, we tested the effect of observed morphognostic features on sex determination and found that the only morphognostic features that had a statistically significant effect on sex determination were prominence of  superciliary arch and glabella and size of mastoid process. Multivariate effect of the prominence of muscle insertions on sex determination is borderline (p=0.052). Conclusion: Univariately, the greatest predictive effect for prediction of male sex is shown by the prominence of superciliary arch and glabella, prominence of muscle insertions and mastoid process. Multivariately, morphognostic features of prominence of superciliary arch and glabella, as well as the size of mastoid process show a statistically significant effect on sex determination. Effect of the prominence of muscle insertions is borderline. Key words: Skull, sexual dimorphism, osteoscopy, binary logistic regression

Introduction: Non Hodgkin lymphoma-Diffuse large B cell lymphoma (DLBC) is composed of more varieties of one disease. Analysis and understanding of a wide range of characteristics of the disease, which include: clinical, immunohistochemical, cytogenetic and molecular characteristics may improve treatment results. Aim: achieving the estimated three-year survival and influence of IRF/MUM1 expression to three-year survival. Material and methods: A study was retrospective–prospective, patients were followed for seven years a period of dine. The study included 60 patients de novo DLBCL. Age was 18-72 years old, the average age 45 years, male 31 (51,7%) and female 29 (48.3%). Median follow-up was 47 months (3-91 months). To determine differentiation immunophenotype antibodies those were used anti-CD20, anti-CD10, anti-Bcl-6, IRF-4/MUM1, CD 138. Results: Included the GCB type was 65%. Impact prognostic index IPI>2 GBC vs non GBC p=0,038 X2. Statistically significant difference was confirmed compared to the IPI> 2 to 3 year OS p<0,0005 X2. Significantly longer three-year survival was provided in the group GCB 36 (92,3%) vs. non GCB 8 (38,1%) p=0,003 X2. Clinical and immunohistochemical factors showed a significant impact to three-year survival by univariate: LDH p=0,005, MUM1 p=0,003, while CD10 p=0,069 was confirmed on the level of borderline impact. Using multivariate analysis, expression MUM1 has the greatest impact p<0.0005 OR=0.083 (95% CI 0.23-0.303) on the disease outcome – three-year survival. Conclusion: expression MUM1 >25% has the greatest impact on the disease outcome – three-year survival.

Objectives: The aim of this study was to evaluate visual and refractive outcomes after Veriflex phakic intraocular lenses (pIOL) implantation in moderately myopic eyes as well as postoperative complications. Methods: This prospective clinical study included 40 eyes of 26 patients which underwent implantation of Veriflex for correction of myopia from -6.00 to -14.50 diopters (D) in the Eye Clinic Svjetlost Sarajevo, from January 2011 to January 2014. Uncorrected distance visual acuity (UDVA), manifest residual spherical equivalent (MRSE), intraocular pressure (IOP), endothelial cell (EC) density were evaluated at one, three, six and 12 months. Other complications in postoperative period were evaluated. For statistical analysis SPSS for Windows and Microsoft Excel were used. Results: Out of 26 patients 14 had binocular and 12 monocular procedure, with mean age of 29.8±6.5 years. After 12 months mean UDVA was 0.73±0.20. Mean MRSE was -0.39±0.31D and 90% of eyes had MRSE within ±1D. EC loss was 7.18±4.33%. There was no significant change of IOP by the end of 12 months follow up period. The only intraoperative complication was hyphema and occurred in one eye. Few postoperative complications were: subclinical inflammation in three eyes (7,5%), pigment dispersion in four eyes (10%), ovalisation of papilla in 2 eyes (5%) and decentration of pIOL in 2 eyes (5%). Conclusion: Implantation of iris-claw phakic lenses Veriflex for treating moderately high myopia is a procedure with good visual and refractive results and few postoperative complications.

AIM To evaluate efficacy and safety of iris-supported phakic lenses (Verisyse) for treating moderately high myopia. METHODS This prospective clinical study included 40 eyes from 29 patients, who underwent implantation of Verisyse for correction of myopia from -6.00 to -14.50 diopters (D) in the Eye Clinic ''Svjetlost'', Sarajevo, from January 2011 to January 2014. Uncorrected distance visual acuity (UDVA), manifest residual spherical equivalent(MRSE), postoperative astigmatism, intraocular pressure(IOP), endothelial cell (EC) density were evaluated at one, three, six and twelve months. Corrected visual acuity (CDVA), index of safety and efficacy were evaluated after 12 months. RESULTS Out of 29 patients 15 were males and 14 females, with mean age of 27.9 ± 5.0. After 12 months 77.5% eyes had UDVA ≥ 0.5 and 32.5% had UDVA ≥ 0.8. Mean MRSE was 0.55D ±0.57D and mean postoperative astigmatism -0.86D ± 0.47D. Efficacy index was 1.09 ± 0.19 and safety index 1.18 ± 0.21. One eye(2.5%) lost two Snellen lines and three eyes (7.5%) one line, 11 eyes (27.5%) gained one line, and five eyes (15.5%) gained two lines. EC loss after 12 months was 7.59 ± 3.05%. There was no significant change of IOP after one year follow up. CONCLUSION Implantation of iris-supported phakic lenses (Verisyse) for treating moderately high myopia is an efficient and safe procedure.

Viral infections augment immediate and late allergic responses in the lungs of patients with allergic asthma. Certain viruses that typically exacerbate asthma have been noted to induce release of the cytokine interleukin-11 (IL-11) which is associated with airway hyperreactivity (AHR). The aim of study: To determine the frequency of influenza-like illness in patients with allergic asthma on immunotherapy compared to the patients with allergic asthma receiving only antiasthmatic pharmacotherapy during the period of 1-year follow up. Methods: In our study, we included 60 patients with allergic asthma, both genders who were subsequently divided into two treatment groups. Study group included 30 patients who received immunotherapy (immunotherapy group) and control group included 30 patients treated with standard pharmacotherapy, but not with immunotherapy (GINA proposal). Results: There was a significant difference in influenza-like illness (ILI) between immunotherapy and control group of patients. A significantly higher percentages of patients in control group experienced cold and/or flu syndrome compared to immunotherapy group, which was observed at the 2nd, 3rd and 4th trimester (X2= 20.480 p=0.0001). During the first trimester there was no difference in the number of patients with the cold/flu symptoms between the immunotherapy and control group. During the 2nd trimester, there was a significant decrease in the number of patients with cold/flu symptoms 3/30 (10%) in the immunotherapy group, while in the control group there was significantly higher number of patients with the cold/flu symptoms (11/30 (36 %)). In the 3rd and 4th trimester the frequency of patients with cold/flu symptoms was unchanged compared to the 2nd trimester in the immunotherapy group, while in the control group the frequency of patients with cold/flu symptoms increased from 20/30 (66%) at the 3rd to 27/30 (90%) in the 4th trimester. The number of patients reported to the physician due to bronchial hyperreactivity was dependent on the immunotherapy treatment (p=0.0001) Conclusions: The frequency of influenza-like illness occurrence was significantly lower in patients treated with immunotherapy during one year of follow-up compared to the patients treated with antiasthmatic pharmacotherapy. The percentage of patients with influenza-like illness was 10% in the patients treated with immunotherapy at third and fourth trimester of the follow-up, whilst in patients on antiasthmatic pharmacotherapy, the percentage of patients with influenza-like illness increased from 66% in the third to 90% in the fourth trimester.

Allergen immunotherapy significantly reduced asthma symptoms and medications requirements. Treated patients were significantly less likely to report symptomatic deterioration and less likely to require increased medication. This immunotherapy showed no consistent effect on lung function. The aim of study: In this study, we have determined the difference in the frequency and intensity of bronchial hyper-reactivity in patients with allergic asthma on immunotherapy compared to the patients with allergic asthma receiving only anti-asthmatic pharmacotherapy during one year period of time. Methods: 60 patients were included with allergic asthma, where genders were subsequently divided into two treatment groups. The study group included 30 patients who had received immunotherapy (immunotherapy group) and control group of 30 patients treated with standard pharmacotherapy, but not with immunotherapy (GINA proposal). Each patient in the immunotherapy group was treated with subcutaneous specific immunotherapy (SCIT). The criteria for the inclusion of the patients were clinical diagnosis of allergic asthma, age between 15 and 30 years, and both sexes. The criteria for the exclusion of the patients were the presence of other acute and chronic diseases of respiratory airways, other allergic diseases (skin allergies, nutritive allergies etc.), and acute and chronic diseases of other organic systems. Results: During the 1st trimester, the median FEV1 values in control group of patients was 60.5% (46.7-78.25%) and following bronchodilators therapy, it was 81% (56-82.2%), which was a significant (p=0.005). In the immunotherapy group, median FEV1 value was 74% (66.0-77.0%) and following bronchodilator therapy it was 84% (76-89.5%), which was a significant increase (p=0.005). During the 2nd trimester, the median FEV1 value in control group of patients was 75% (50-79.5%) and following bronchodilators therapy it increased up to 84% (66-88.5%) but the difference was not significantly different (p=0.08). In immunotherapy group, median FEV1 value was 78% (75.5-79.0%) and following bronchodilator therapy, it increased to 82% (79.5-83.75%) but the difference was not significant (p=0.066). During the 3rd trimester, the median FEV1 value in control group of patients was 70% (43-75%) and not significantly increased following bronchodilators therapy up to 84% (51-85%) (p=0.08). In experimental (immunotherapy) group, median FEV1 value was 77% (70-79%) and following bronchodilator therapy, it did not significantly change 76% (68-85%) (p=0.273). During the 4th trimester, the median FEV1 value in control group of patients was 65% (54-75%) and significantly increased following bronchodilators therapy to 79% (55-83%) (p=0.018). In immunotherapy group, median FEV1 value was 79% (68-79.5%) and did not change significantly following bronchodilator therapy 90% (67.5-95.75%)) (p=0.18). Conclusion: In this study, the frequency of bronchial hyper reactivity was not significantly different in patients with allergic asthma treated with immunotherapy compared to the patients receiving only anti-asthmatic pharmacotherapy during one year period of time. Although the decrease was not significant (χ2=3.166 p=0.065) in our sample, there was a trend toward a decrease in BHR in our patients treated with specific immunotherapy.