Aim To compare the effect of neoadjuvant chemotherapy based on taxane and/or anthracycline to the extent of an objective response in female patients with unresectable breast cancer with evaluation of the toxic profile of applied chemotherapy. Methods One hundred patients with histologically verified breast cancer, treated with neoadjuvant chemotherapy were divided into two groups: a study group A (50 patients), who had received 4 to 6 cycles of taxane-based chemotherapy, and control group B (50 patients), who had received 4 to 6 cycles of anthracyclines-based chemotherapy. Pathohistological response was evaluated after tumour excision and axillary resection at the end of chemotherapy and it was defined as pathologic complete (pCR), partial (pPR), or no response (pNR). Toxic effects were evaluated and quantified by the Common Terminology Criteria for Adverse Events v4.0. Results After neoadjuvant chemotherapy, 8% of patients in the group A achieved pCR, 54% achieved pPR, while 38% of patients had no tumour response to applied chemotherapy. In the group B pCR was achieved in 6%, pPR in 42% of patients, while 51% of patients were pNR to the administered chemotherapy. Significant reduction of tumour mass was achieved in the group of patients treated with taxanes: 20.00 (7.75-30.25) vs. 13.50 (6.00-25.00) mm (p=0.024). Toxicity of chemotherapy in group A and group B was within the limits of grade 2. Conclusion The addition of taxane to anthracycline-based neoadjuvant chemotherapy in patients with breast cancer resulted in a significant reduction in tumour mass compared to the group of patients treated with anthracyclines, but without increasing the overall side effects.

Aim To investigate the effect of kinesiotherapy on muscle strengthening in patients with Parkinon's disease. Methods This clinical retrospective - prospective study was based on collected data from medical histories and included 40 patients, who, beside medicaments, had undergone kinesiotherapy. This study analysed age, gender, duration of the rehabilitation and estimation of the gross muscle strength at admittance and discharge using Manual Muscle Test (MMT). Results Females was slightly more represented in the total sample without significant statistical difference. After kinesiotherapy significant statistical difference in muscle strength was observed, average MMT of the upper extremities increased from 3.25±0.6 to 3.53±0.8 and on the lower extremities from 2.9±0.8 to 3.3±0.9. The analysis of the gender on the higher score of MMT showed that gender does not affect the score of MMT. Correlational analysis of the age and duration of hospitalization on the score of MMT showed that patients with longer hospitalization had better improvement. Conclusion Results of the study showed that kinesiotherapy has positive effect on muscle strength in patients with Parkinson's disease.

Introduction: By development of the medicine, control of the risk factors for acute myocardial infarction (AMI), became the foundation of cardiology. Aim: To investigate the association of the age with presence of risk factors in patients with acute myocardial infarction. Methods: The study had a prospective, comparative and descriptive character, and it was done on a sample of 80 patients (n=80; 55 male and 25 female) Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo from January 2016 to August 2018. All patients were hospitalized under the diagnosis of myocardial infarction and were divided into two main groups, which were divided into two subgroups according to age. Group A, group of patients under 45 years of age at the moment of diagnosis of AMI (n = 40; men = 29; women = 11) was divided into group A1 (n = 20; patients aged 25-35 years) and group A2 (n = 20; patients aged between 35-45 years). Group B, patients older than 45 years at the time of diagnosis of AMI (n = 40; men = 26, women = 14) was divided into group B1 (n = 20; patients aged between 45-55 years) and group B2 (n = 20; patients aged 55-65 years of age). Results: According to gender distribution, there is a significantly higher incidence of hypertension in male patients aged 25-35 years and between 35-45 years (p = 0.01; p = 0.01). Increased cholesterol values were significantly more common in men aged 25-35 years (p = 0.0121). Increased triglyceride values were significantly more common in men aged 25-35 years, in comparison to female respondents of the same age (86.67% vs. 13.33%, p = 0.0001). There was a significant significance between the two groups in the occurrence of anteroseptal (p = 0.04) and in the diaphragmatic myocardial infarction (p = 0.01), while in other infarction localities no significant significance was observed. Conclusion: Male sex is a predisposing risk factor for the development of a cardiovascular incident in the younger age. The post infarction ejection fraction of the left ventricle was significantly reduced in younger patients. The potential for prevention should be of paramount importance. The localization of the incident itself, and the involvement of a certain blood, represents, regardless of all the research, still a fact that is hard to stratify and directly correlated with a certain risk factor.

Introduction: Spleen acts as blood reservoir both in animals and human beings. Spleen contracts during the exercise and so augment the systemic circulation and helps body to maintain longer on high intensity exercise. Reviewing all available literature, the human spleen shows a decrease in volume, in range from 8% to 56%, depending on the work intensity. Aim: To evaluate the percentage of the decrease in splenic volume after the treadmill exercise at specific workloads: aerobic threshold intensity, anaerobic threshold intensity, submaximal intensity and maximal intensity. Methods: This prospective study with repeated measurements included 16 healthy subjects, divided in two groups. First group consisted of 8 elite long-distance runners and second group of 8 recreational runners. First testing consisted of treadmill ergospirometry test. This data was crucial for the second testing where subjects were exercising on treadmill at specific workloads. Four specific workloads were determined: treadmill exercise at aerobic threshold intensity (1st workload), anaerobic threshold intensity (2nd workload), submaximal intensity (3rd workload) and maximal intensity (4th workload). Workloads were controlled by the speed of treadmill, for each subject individually regarding the ergospirometry test. Ultrasound measurement of spleen was done before and after each workload. Results: Elite long-distance runners showed greater spleen contraction than recreational runners after four workloads. Spleen contraction was the biggest after the 3rd workload in elite long-distance runners. Smallest contraction was in group of recreational runners after the 1st workload. Statistically significant difference was not found between the groups, regarding the splenic volume after exercise at four specific workloads (p>0.05). Conclusion: Elite long-distance runners had greater decrease in splenic volume than recreational runners, after exercise at four specific workloads, without significant difference. Greatest decrease happened in elite long-distance runners, after exercise at submaximal intensity - 49% decrease in splenic volume.

The purpose of this paper was to choose an appropriate information dissimilarity measure for hierarchical clustering of daily streamflow discharge data, from twelve gauging stations on the Brazos River in Texas (USA), for the period 1989–2016. For that purpose, we selected and compared the average-linkage clustering hierarchical algorithm based on the compression-based dissimilarity measure (NCD), permutation distribution dissimilarity measure (PDDM), and Kolmogorov distance (KD). The algorithm was also compared with K-means clustering based on Kolmogorov complexity (KC), the highest value of Kolmogorov complexity spectrum (KCM), and the largest Lyapunov exponent (LLE). Using a dissimilarity matrix based on NCD, PDDM, and KD for daily streamflow, the agglomerative average-linkage hierarchical algorithm was applied. The key findings of this study are that: (i) The KD clustering algorithm is the most suitable among others; (ii) ANOVA analysis shows that there exist highly significant differences between mean values of four clusters, confirming that the choice of the number of clusters was suitably done; and (iii) from the clustering we found that the predictability of streamflow data of the Brazos River given by the Lyapunov time (LT), corrected for randomness by Kolmogorov time (KT) in days, lies in the interval from two to five days.

Aim To investigate existence of scientific support for linking differences in the experience of pain to ethnicity. Methods The study was designed as a systematic literature review of qualitative and quantitative studies. The inclusion criteria were scientific studies published in scientific journals and written in English. Studies that described children's experiences and animals were excluded. There were 10 studies, one qualitative and nine quantitative. Results The result was divided into two main sections. The first section presents the results of investigated material regarding different ethnic groups, the groups' different experiences with regard to pain and its treatment focusing entirely on the patients' perspective. Several studies have revealed major differences in the way individuals perceive their pain, using various pain evaluation tools. The second section explained different coping strategies depending on ethnicity and showed that different ethnic groups handle their pain in different ways. Conclusion Healthcare professionals have a duty to pay attention to and understand the patients' experience of their disease and suffering and, as far as possible, mitigate this using appropriate measures. For this purpose, ethnic, cultural and religious differences between different patients need to be understood. It is necessary to continue to study ethnic differences in reporting and predicting pain and its consequences, including the assessment of variables associated with pain, as well as examining the use of prayer as a form of dealing with pain, with an evaluation of various effects of such different influences.

Aim To explore the experience of anaesthetist nurses in brief meetings with immigrant patients in the perioperative setting. Methods The study was conducted through open individualised interviews using open-ended questions. Eighteen anaesthetist nurses (six men and twelve women) participated in the interviews. Their age varied between 35 and 65 and they had worked as anaesthetist nurses for a period between six and twenty eight years. The text was analysed using qualitative content analysis. Results Meetings with immigrant patients made nurses with less experience to prepare more, to study behaviour of these patients and to ask their older colleagues for advice. More experienced nurses acted on the basis of their previous experience and treated the patients in the same way as before. They also emphasised the great responsibility and wider scope of assistance needed by these patients than those born in Sweden. The majority of nurses begin the meetings with these patients by requesting an interpreter, while some nurses begin the meeting directly with the patient and, if they see it is not going well, they request an interpreter. Conclusion Nurses need better guidelines and education in how to deal with the legislation relating to immigrant patients in order to handle the situation more effectively. Training in cross-cultural care should be improved to help nurses deal with stress through co-operation with the Migration Board and others. In order to provide for good communication and patient safety professional interpreters should be used.

Aim To investigate etiological link between acute myocardial infarction (AMI) and the accompanying impotence/erectile dysfunction (ED). Methods Study included 99 male patients (48 who had AMI - patient group, and 51 healthy examinees without previous cardiovascular disease - control group). All patients completed a standardized questionnaire, the International Index of Erectile Function (IIEF-5). Results Older patients had significantly lower IIEF-5 score (negative correlation) (p<0.05), but higher ED degree (significant positive correlation) (rho=0.522; p=0.0001). In the patient group, 37 (77.1%) patients had ED, while in the control group it was found in 26 (51%) examinees (p<0.05). A clear correlation was found between incidence of ED and diabetes, dyslipidaemia, hypertension and positive family history (they were more common in patients with ED, with no statistically significant difference). There was no statistically significant difference between patients with ED and patients without ED according to the beta-blocker usage (p=0.824): ED was reported in 11 (68%) patients in the group who used carvedilol, 14 (82.3%) in the group who used metoprolol, and nine (81.8%) who used nebivolol. Conclusion Myocardial infarction as well as age are directly related to the occurrence of ED. Cardiovascular risk factors are in direct correlation for the occurrence of erectile dysfunction after myocardial infarction.

Aim To determine dietary habits of elementary school students in relation to a place of living and socio-economic status of the family. Methods A prospective study conducted in the Primary Health Center Zenica involved five family medicine teams in urban and five in rural settlement during 2015. Elementary school students aged 10-16 were interviewed by random selection using a questionnaire on the socio-economic status of parents and nutritional habits of adolescents. Results The survey involved 199 respondents, 103 from rural and 96 from urban area. There were significantly more pupils from employed parents who consumed non-carbonated drinks. Students from urban areas more likely consumed fruit every day than children from rural areas. More than half of the respondents did not or rarely consumed vegetables, in this case the village pupils, who consumed much less milk. It would be expected that rural students were more likely to consume fruits, vegetables and milk due to easier access to these foods in the countryside, but the results of this research did not confirm this assumption. Conclusion Changes in traditional family functioning (lower income, unemployment) could be linked with lifestyle changes (low consumption of fruits and vegetables, low consumption of milk both in rural and urban areas, consumption of carbonated drinks), especially in families in rural areas.

Aim To develop an online biofilm calculation tool (Biofilm Classifier), which calculates the optical density cut off value and accordingly determines the biofilm forming categories for the tested isolates by standardized formulas, as well as to compare the results obtained by Biofilm Classifier to manual calculations and the use of predefined values. Methods The biofilm forming capacity of tested strains was evaluated using tissue culture plate method in 96 well plates, and optical density (OD) value of the formed biofilm was measured on an ELISA Microplate reader at 595 nm on a total of 551 bacterial isolates from clinical specimen. Results Comparative analysis indicated that the manual calculation was 100% in accordance with results obtained by the designed software as opposed to the results obtained by use of predefined values for biofilm categorization. When using predefined values compared to manual biofilm categorization for the determination of biofilm positive and biofilm negative strains the specificity was 100%, sensitivity 97.81%, positive predictive value 100%, negative predictive value 96.04% and accuracy 98.57%. Conclusion Considering obtained results, the use of the designed online calculator would simplify the interpretation of biofilm forming capacity of bacteria using tissue culture plate method.

Aim To present our experience with a diagnostic ability of endoscopic ultrasound (EUS) and magnetic retrograde cholangiopancreatography (MRCP) in cases of choledocholithiasis verified by endoscopic retrograde cholangiopancreatography (ERCP). Methods This retrospective study was conducted after a collection of data involving 58 suspected choledocholithiasis patients who underwent ERCP from January 2013 to December 2015. Patients who were diagnosed with choledocholithiasis on the basis of clinical symptoms and radiological findings and who underwent ERCP were included in this study. The first group (29 patients) underwent EUS, and the second group (29 patients) underwent MRCP. The ERCP was performed in both groups. Sensitivity, specificity and diagnostic accuracy of EUS and MRCP were determined by comparing them with ERCP, which was considered to be a gold standard. Results Gender representation was in favour of males, 58:42%. The mean age was 55.5 years. In the group 1 (EUS) 22 patients were found to have choledocholithiasis using ERCP. The EUS stone detection rate was 88%. Endoscopic ultrasound showed sensitivity (97%), specificity (67%) and accuracy (88%), positive predictive value (PPV) of 88%, negative predictive value (NPV) of 80%. In the group 2 (MRCP) 16 patients were found to have choledocholithiasis by ERCP. MRCP sensitivity was 81%, specificity 40%, PPV of 74%, NPV of 50%. Conclusion The EUS was a superior non-invasive tool in comparison with MRCP for detecting choledocholithiasis, which was confirmed using ERCP.

Introduction The exact mechanisms of periapical bone resorption have not been fully elucidated. This study aimed to analyze the expression of Notch signaling molecules (Notch2, Jagged1, and Hey1) and proinflammatory cytokines (tumor necrosis factor alpha [TNF‐&agr;], interleukin [IL]‐1&bgr;, and IL‐6) in human apical periodontitis lesions with different receptor activator of nuclear factor kappa B ligand (RANKL)/osteoprotegerin (OPG) ratios and determine their potential correlation. Methods The study group consisted of 50 periapical lesions collected in conjunction with apicoectomy. The relative gene expression of the investigated molecules (Notch2, Jagged1, Hey1, RANKL, OPG, TNF‐&agr;, IL‐1&bgr;, and IL‐6) in all tissue samples was analyzed using reverse transcriptase real‐time polymerase chain reaction. The Student t test, Mann‐Whitney U test, and Spearman correlation were used for statistical analysis. Results Based on the RANKL/OPG ratio, periapical lesions were either RANKL predominant (RANKL > OPG, n = 33) or OPG predominant (RANKL < OPG, n = 17). Symptomatic lesions occurred more frequently in RANKL‐predominant compared with OPG‐predominant lesions (24 vs 7, P = .029). Notch2, Jagged1, Hey1, and TNF‐&agr; were significantly overexpressed in lesions with predominant RANKL compared with lesions with predominant OPG (P = .001, P = .001, P = .027, and P = .016, respectively). Significant correlations were observed between the investigated genes in periapical lesions. Conclusions Notch signaling appeared to be activated in periapical inflammation. An increase in Notch2, Jagged1, Hey1, and TNF‐&agr; expression in RANKL‐predominant periapical lesions corroborates their joined involvement in extensive periapical bone resorption.

Aim To investigate the prevalence and obstetrical characteristics of low birth weight infants (LBWIs) in ten Cantons of the Federation of Bosnia and Herzegovina (FBiH). Methods The prospective study included newborns of both genders, gestational age (GA) of 22 to 42 weeks and birth weight(BW) of less than 2,500 grams in the period 1 January 2009 to 31 December 2009. Results In the observed period, 22897 neonates were born, out of whom 669 (2.9%) had a BW less than 2500 grams (average BW was 1295 grams; SD ± 234.2; a coefficient of variation of 0.58). The average GA was 31.4 weeks of gestation. The average lifespan of mothers was 27.7 years (SD ± 1.2). The average Apgar scor (AS) in the first minute was 4.6 (SD ± 2.1) and in the fifth minute it was 6.6 (SD ± 1.9). The LBWIs were most commonly delivered by primiparas, 317 (47.5%). Of the 669 LBWIs, 411 (61.4%) were born per vias naturalis, with cephalic presentation. The highest number of LBWIs was born in Sarajevo Canton, 3.7%, and Central Bosnia Canton, 3.7%. The lowest prevalence was in Posavina Canton, 1.1%. The largest late fetal mortality was in Central Bosnia Canton, 7.7 ‰. Conclusion This study has determined a relatively low prevalence of LBWIs and other examined obstetrical characteristics that are in correlation with European and Global World data.

Neuroendocrine breast cancer (NEBC) is a group of rare tumors, which could benefit from therapy targeting the somatostatin receptors (SSTRs). In particular, SSTR2A and SSTR5 are potential targets given their consistent expression in gastrointestinal and pancreatic primary and metastatic neuroendocrine cancers. Currently, there are no studies describing the expression of SSTRs in NEBC. The purpose of our study was to characterize the immunohistochemical expression of SSTR2A and SSTR5 in a cohort of NEBC. Thirty-one primary NEBC cases were analyzed, and SSTR2A and SSTR5 immunohistochemistry performed and scored using the modified immunoreactive score proposed by Remmele and Stanger. All patients were females with a mean age of 66.6 years (SD = 14). 77% of cases were histological grade 2. SSTR2A showed a weak positivity in 11 cases (35.5%), moderate positivity in 6 cases (19.4%) and strong positivity in 5 cases (16.1%). Nine cases were negative for SSTR2A (29%). SSTR5 showed a weak positivity in 16 cases (51.6%), moderate positivity in 6 cases (19.4%), while no cases showed strong positivity. Nine cases were negative for SSTR5 (29%). Five cases were negative for both SSTR2A and SSTR5. A weak to moderate SSTR2A and SSTR5 expression was observed in 50-70% of the cases. A subset of NEBCs with strong SSR2A expression may benefit from SSTRs targeted therapy. These results need further validation in a larger series including metastatic NEBC, to provide potential therapeutic targets for patients with advanced disease.