The objective of this study was to investigate causal associations between cattle farms’ management practices and reproductive disorders (abortion, stillbirth, retention of placenta, metritis). Besides, direct causal associations between farms’ management and reproductive infections (Chlamydia abortus, Coxiella burnetii, and Neospora caninum), reproductive disorders and infections were also investigated in this study. As a secondary objective, constraints that affect the production in cattle farms were examined. The study was carried out in the north-western (Una-Sana), western (Canton 10) and central part (Central Bosnia Canton) of Bosnia and Herzegovina. A total of 201 farms were selected for participation. A semi-structured questionnaire-based interview was conducted among farmers/managers from January 1st to August 31st, 2015. The 40 questions were divided into three groups: socio-demographic, management, and information on reproductive performances in cattle. Supplementary questions were asked about the perceived primary constraints of the production. A multivariable mixed-effects logistic regression was used to screen management factors for potential statistical influence. All investigated outcomes were associated with farms’ management. The final multivariable models were merged into a Structural Equation Model (SEM). The causal model was then specified graphically. The SEM model showed that herds that experienced abortions (OR=4.3) and stillbirth (OR=6.7) were associated with N. caninum seropositivity. Also, herds that experienced retention of placenta were strongly associated with the occurrence of metritis (OR=10.1). C. abortus and C. burnetii herd seropositivities were mainly associated with environmental factors and contact with potential intermediate hosts. Our study demonstrated that management practices on dairy farms in Bosnia and Herzegovina contributed to the occurrence of severe reproductive outcomes and reproductive infections. N. caninum seems to be an infectious agent that substantially contributed to the reproductive underperformance. Further we demonstrate the need for using causal models in understanding complex relationships.

Of the four species of the genus Satureja (Lamiaceae) that are recognized in Bosnia and Herzegovina, S. subspicata has the the widest distribution. It is taxonomically challenging species of geographically limited distribution and little data on its genetic diversity throughout its range is available. We sampled six geographically distinct populations from Bosnia and Herzegovina and applied nrDNA (ITS1, ITS2), chloroplast markers (matK and trnL) and AFLP to examine genetic diversity of S. subspicata in the center of its distribution range and to explore the possibility of establishing the species DNA barcode. AFLP analysis showed large genetic differentiation among populations as well as moderate correlation between genetic distance among populations and geographic distance among locations. MatK has not proven useful in distinguishing S. subspicata from sympatric species. However, nrDNA sequences provided necessary resolution power, with ITS2 being more informative. Estimates of evolutionary divergence between nrDNA sequences obtained in our research and homologous sequences of sympatric Satureja deposited in the GenBank reveal closer relationship between geographically proximate populations of different species and slight divergence within S. subspicata sequences pool. This outcome highlights the importance of considering overall genetic diversity across the distribution range of a species when assigning DNA barcode.

Objective: The accuracy and applicability of various cardiovascular disease (CVD) risk calculators may not be same in different populations. Wecompared 5 RFS for CVD risk on patients from Bosnia an...

The research was conducted on a sample including 166 participants - students of 'Combined Technical High School" of male sex from Travnik, who attended physical education classes regularly during the school year. In the research five variables were used to assess morphological status and nine variables to assess motor status of the participants according to the Eurofit Fitness Test Battery. The main aim of the research was to determine quantitative changes in morphological and motor status of secondary school students during one school year under the impact of programme content of regular physical education classes through a longitudinal study. Quantitative changes in morphological and motor status and analysis of differences between the initial and final measurements were determined by analysis of changes under the model of differences and SSDIF analysis (Bonacin, 2004). A hypothetical measurement matrix was defined by projecting the measurement data, and explicating a set of linear shifts on the association matrix resulted in obtaining structural vector describing quantitative changes, while taking into account relations of the initial variables. Results of the SSDIF analysis indicate that a one-year curriculum of physical education has caused statistically significant changes at global level (p = 0.0000) in both investigated areas, but the changes that have occurred are mild and without dramatic changes. Significant quantitative changes in the motor space occurred in body height and weight, and in the triceps skinfold, as well as in the following variables in the motor space: running 105 m (sideways), lifting the trunk from the lying on back position and the hand dynamometry, and the biggest and most statistically significant global quantitative changes occurred in the 20 m test run sideways with progressive acceleration (ATL20 0.8439). Key words: quantitative changes, morphological characteristics, motor skills, Physical and Health Culture Analiza kvantitativnih promjena morfoloko-motoričkih obilježja učenika srednje kole pod uticajem redovne nastave tjelesnog odgoja Istraživanje je provedeno na uzorku ispitanika koji je obuhvatio 166 ispitanika - učenika Mjeovite srednje tehničke kole mukog spola iz Travnika koji su u toku kolske godine redovno pohađali nastavu tjelesnog odgoja. U istraživanju je primijenjeno 5 varijabli za procjenu morfolokog statusa i 9 varijabli za procjenu motoričkog statusa ispitanika prema programu Eurofit baterije testova. Osnovni cilj istraživanja bio je da se longitudinalnom studijom u trajanju jedne kolske godine utvrde kvantitativne promjene morfolokog i motoričkog statusa učenika srednje kole pod utjecajem programskih sadržaja redovne nastave tjelesnog odgoja. Kvantitativne promjene morfolokog i motoričkog statusa i analiza razlika između inicijalnog i finalnog mjerenja utvrđeni su analizom promjena pod modelom razlika i SSDIF analizom (Bonacin, 2004). Projekcijom podataka mjerenja definisana je hipotetska matrica mjerenja, a eksplikacijom skupa linearnih pomaka na matricu asocijacije dolazi se do strukturnog vektora koji opisuje kvantitativne promjene, uvažavajući relacije inicijalnih varijabli. Rezultati SSDIF analize ukazuju da je jednogodinji nastavni program tjelesnog odgoja izazvao statistički značajne promjene na globalnom nivou (p = 0.0000) u oba istraživana prostora, ali su nastale promjene blage i bez dramatičnih promjena. Do statistički značajnih kvantitativnih promjena u motoričkom prostoru dolo je u tjelesnoj visini i težini, te kožnom naboru tricepsa, a u motoričkom prostoru u varijablama: trčanje 105 m (tamo-ovamo), dizanje trupa iz ležanja na leđima i dinamometrija ake, a najveće i statistički najznačajnije globalne kvantitativne promjene desile su se u testu trčanje na 20 m tamo - ovamo sa progresivnim ubrzavanjem (ATL20 0.8439). Ključne riječi: kvantitativne promjene, morfoloke odlike, motoričke spsosobnosti, tjelesna i zdravstvena kultura

Objective - To present the most efficatious management of raised intracranial pressure after severe trauma brain injury in a pediatric patient. Case report - A 5-year-old Caucasian presented to the emergency room due to head injury caused by falling down stairs. At the time of admission the patient was comatose with pediatric Glasgow Coma Score 6 (V-1, E-1, M-4) and signs of recent posterior head trauma. Computed tomography (CT) scan showed a multifragmented fracture of the occipital bone above the “sinus lake” causing an epidural mass, contusion in the right cerebellar hemisphere, a skull base fracture without signs of midline shifting. Six hours later, during monitoring in the intensive care unit, the patient became cardiorespiratory unstable with signs of uncal brain herniation and Cushing’s triad. Control CT revealed previously verified posttraumatic changes with new signs of decompensating internal hydrocephalus. Considering that evacuation of the epidural collection and decompression of impaired bone fragments in the area of the “sinus lake” would be too risky, extraventricular drainage as the first tier management was properly selected as the option of treatment. Taking into account the hazard / benefit ratio it was shown to be the most effective form of treatment, which was confirmed after six-month follow-up without any form of neurocognitive impairment. Conclusion – Treatment of traumatic brain injury (TBI) in the pediatric population requires a multidisciplinary approach. Different mechanisms of pediatric TBI injury vary widely by age groups and its impact on the development of primary and secondary brain lesions differs. Although many general principles of managing pediatric TBI are similar to adults, cerebral plasticity is one of the features which ultimately always leaves space for a better final outcome of treatment.

Summary Background FTO, a gene recently discovered in genomewide associated studies for type 2 diabetes mellitus (T2D), play an important role in the management of energy homeostasis, nucleic acid demethylation and regulation of body fat mass by lipolysis. The aim of this study was to analyze the association of FTO rs8050136 A>C genetic variant with clinical and biochemical parameters of T2D in the population of West Balkan region (Bosnians and Herzegovinians and Kosovars). Methods The study included 638 patients with T2D and prediabetes and 360 healthy controls of both genders, aged from 40 to 65 years. Patients were recruited at the Clinical Centre University of Sarajevo, University Hospital of Clinical Centre in Banja Luka, General Hospital in Tešanj and Health Centre in Prizren. Genotyping of analyzed FTO polymorphism rs8050136 A>C was performed by qPCR allelic discrimination. Results Genotype frequencies of the analyzed polymorphism were comparable between patients with T2D, prediabetic patients, and healthy population. Logistic regression analyses didn’t show significant association of FTO rs8050136 A allele with increased risk of T2D. However, risk A allele was significantly associated with higher levels of HbA1c, insulin, HOMA-IR index, diastolic blood pressure, and inflammatory markers (fibrinogen and leukocytes) as well as showed tendency of association with increased values of obesity markers (BMI, waist and hip circumference). Conclusions Results of our study showed a significant association of FTO genetic variant rs8050136 A>C with the major markers of insulin resistance, obesity and inflammation, opening new avenues for solving many unclear questions in the pathogenesis of T2D.

In 2012, a European initiative called Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile localised scleroderma (JLS) is a rare disease within the group of paediatric rheumatic diseases (PRD) and can lead to significant morbidity. Evidence-based guidelines are sparse and management is mostly based on physicians’ experience. This study aims to provide recommendations for assessment and treatment of JLS. Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was formed, mainly from Europe, and consisted of 15 experienced paediatric rheumatologists and two young fellows. Recommendations derived from a validated systematic literature review were evaluated by an online survey and subsequently discussed at two consensus meetings using a nominal group technique. Recommendations were accepted if ≥80% agreement was reached. In total, 1 overarching principle, 10 recommendations on assessment and 6 recommendations on therapy were accepted with ≥80% agreement among experts. Topics covered include assessment of skin and extracutaneous involvement and suggested treatment pathways. The SHARE initiative aims to identify best practices for treatment of patients suffering from PRDs. Within this remit, recommendations for the assessment and treatment of JLS have been formulated by an evidence-informed consensus process to produce a standard of care for patients with JLS throughout Europe.

Abstract Recurrent myocarditis is rare with only few reports having been published for paediatric cases. Repeated use of extracorporeal membrane oxygenation is also uncommon. In this paper we will present a very rare case of a 7-year old girl with recurrent fulminant myocarditis with heart failure requiring cardiopulmonary resuscitation and mechanical circulatory support with extracorporeal membrane oxygenation. Both episodes were precipitated by a viral upper respiratory tract infection, and in both cases the cardiac function eventually completely recovered. The second episode of fulminant myocarditis was particularly complex with markedly elevated markers of myocardiocytolysis, multiorgan dysfunction and the need for prolonged mechanical circulatory support. Nevertheless, the patient made a remarkable recovery. A comprehensive diagnostic workup pointed towards an aberrant immune response as the likely cause of the girl’s susceptibility for fulminant myocarditis.

Background and objectives: Pharmaceutical literacy skills of parents are crucial for appropriate and safe medication use in pre-school children (ages 1–7 years). A recent study on pharmacotherapy literacy from Serbia showed that one in five parents have difficulty understanding common information about the use of medicines. Because antipyretics are considered to be the most frequently used group of over-the-counter (OTC) medications during the pre-school period, we aimed to: (i) examine parental practice and expectations in antipyretic medication use, and (ii) analyze associations of parental practice and expectations related to socio-economic status and pharmacotherapy literacy. Materials and methods: A cross-sectional survey using a self- report validated specific instrument was conducted with the parents of pre-school children in kindergartens in Belgrade, Serbia. Pharmacotherapy literacy refers to the knowledge and personal skills needed to meet the complex demands of medicine use in both healthcare and non-healthcare settings. A comprehensive literature review, expert-focus group consultation, and pre-testing were employed in 4-item multiple-choice test development to explore practice and expectations related to the use of OTC pediatric antipyretic medicines. Results: The final analytical cohort was comprised of 813 participants, the majority (63.3%) chose a medicine based on a physician’s suggestion and only 15.4% of parents reported they would follow the advice of a pharmacist. More than a half of parents (54.1%) would need advice about antipyretic medicine from a pharmacist, firstly in a simpler language. Parents satisfied with the information given by a pharmacist had higher pharmacotherapy literacy, compared to parents with lower levels (OR–0.718, 95%CI (0.597–0.865), p < 0.001). Men had a higher expectation of pharmacists to explain medicine use in a simpler language (OR–1.630, 95%CI (1.063–2.501), p = 0.025), as well as parents with three or more children (OR–2.527, 95%CI (1.43–4.459), p = 0.001). Parents with higher knowledge about medicine use were less likely to ask for simpler information (OR–0,707; 95%CI (0,583–0,856), p < 0,001). Conclusions: Our main finding is that practice in antipyretic OTC medicine use was associated with levels of parental pharmacotherapy literacy. The expectations of pharmacists were higher among parents with lower levels of pharmacotherapy literacy, who expected more information in a simpler and more precise language. This study highlighted the need for pharmacists to identify risks in parental practice and to provide information about medicines to parents of pre-school children in a simpler and more appropriate way.

Aim: The aim of this study was to analyze risk factors and outcome of neonatal pneumothorax in Tuzla Canton. Methods: Neonates with chest X-ray confirmed pneumothorax in University Clinical Center of Tuzla, within a three-year period, from January 2015 to December 2017, were retrospectively studied. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax, accompanying disorders and mortality. Results: During the observed three-year period 11425 neonates were born in Tuzla Canton, with 7.33 % of preterm births, and 604 neonates were treated in NICU, with 265 neonates who required mechanical ventilation. Neonatal pneumothorax (NP) was diagnosed in 22 patients (9 term, 13 preterm), 12 (54.5%) were male. The incidence was 0.20% of total births, respectively 3.64% of those treated in NICU. The mean gestational age were 35.1 ± 3.0 weeks and birth weight 2 506.8 ± 727.7 grams. NP was mostly unilateral (72.7%) and right-sided. The most commonly associated diseases were: respiratory distress syndrome, intracranial haemorrhage, pneumonia, transient tachypnea and sepsis. In 8 (36.4%) neonates, the underlying cause of NP could be mechanical ventilation (secondary), whereas in 14 (63.6%) NP was spontaneous, without previous mechanical ventilation, although 11 of them required mechanical ventilation after pneumothorax. Conclusion: All perinatal risk factors were investigate, and significant differences in two observed groups related to mechanical ventilation were found for birth weight, gestational age, Caesarean section, length of mechanical ventilation, surfactant replacement therapy and outcome. Three (13.64%) neonates with NP died, and among risk factors with poor outcome, significant was only Apgar score in the first minute ≤ 5.

Epidemics control is a continues struggle. In this paper is an attempt to model and then simulate an epidemiological disease known as Cutaneous Leishmaniasis (CL), which is currently affecting large communities in Libya. The model is developed to facilitate the Agent Based Models (ABM) as one of the many tools applied for epidemiological management. Validation of the model is considered by comparing the model's behavior with a trend of field data used by Libyan authorities. The methodology used for describing and designing CL model is derived from nature of the disease mechanisms. The ABM model involves three types of agents: Human, Rodent and Sand-fly. Each agent has its own properties. Additionally, global model parameters are used for following the human infection processes. Several experiments are given for illustrating the model performance, and monitor the number of people infected. Simulation results show that active human agents are more vulnerable to sand-fly bites, and infection rate is increasing or decreasing dependent on number of sand-fly vectors, number of host rodents, and human population awareness level.

Introduction: The concept of quality of life (QoL) is becoming an increasingly important criterion in the assessment of treatment outcomes, health outcomes and in the assessment of the benefit-to-load ratio of drugs or therapies that have equivalent mechanisms of action. Aim: The aim of the study was to evaluate the improvement of quality of life, tolerability of therapy and patient compliance in patients with depression and/or anxiety disorder treated with antidepressants. Methods: The study was designed as a clinical, multicenter, prospective, cohort study involving 682 patients of both sexes diagnosed with depression and/or anxiety disorder observed over the 9 months period. The study was conducted from January to December 2017 in six research centers of the PI Health Center of the Canton of Sarajevo. The patients were divided into three groups: depressive, anxious and mixed anxiety-depressive disorder, and the therapy administered was, paroxetine or escitalopram. MOS (Medical Outcomes Study) sleep scale and Q-LES-Q-SF (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form) scale were used for quality of life evaluation. Patients were observed six times over the course of the study. Results: The results of the MOS questionnaire showed that more than 90 percent of patients with depression and/or anxiety disorder who had taken fluoxetine, paroxetine or escitalopram for 36 weeks experienced an improvement in the sleep problem index. Sleep duration was greatly improved in all patients regardless of the antidepressants used. The results of the Q-LES-Q-SF questionnaire showed a significant improvement in quality of life as well as overall pleasure and satisfaction with life due to the use of antidepressants. Conclusion: Therapy with fluoxetine, paroxetine and escitalopram leads to a significant improvement of all recorded parameters, along with the overall quality of life, which makes them very effective in the treatment of depression and/or anxiety disorders.

SUMMARY The aim of the study was to analyze correlation between morphological characteristics of intracranial meningiomas and Ki67 labeling index (Ki67 LI), and their influence on peritumoral brain edema (PTBE). There were 41 consecutive patients with intracranial meningiomas surgically treated at the Department of Neurosurgery, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina, during the period from January 2010 to December 2015. We reviewed clinical data including patient age, gender, magnetic resonance imaging (MRI) characteristics of the tumor and peritumoral edema, tumor margins, intraoperative characteristics, histopathologic grade and Ki67 LI. In all cases, follow up MRI was obtained at about three months after resection and PTBE was analyzed. Our research showed the tumor volume, tumor margins, and intraoperative signs of arachnoidal and pial invasion to be associated with PTBE in intracranial meningiomas. Ki67 LI expression correlated with PTBE. This study showed the resolution of PTBE to depend on invasive behavior of meningioma and KI67 LI. PTBE, pial/cortical and arachnoidal invasion significantly influence the extent of surgical resection.