Aim To evaluate the relationship between cardiovascular remodelling and glomerular filtration rate (eGFR) in pre-dialysis chronic kidney disease (CKD) patients without cardiovascular diseases (CVD) and in renal transplant recipients (RTR). Methods The cross-sectional study included 83 patients with eGFR<60 mL/min/1.73m2 (45 with CKD 3 stage and 38 with CKD 4 stage). Thirty six RTR had eGFR 67.8 (57.3-73.7) mL/ min/1.73m2 and control group consisted of 44 patients with eGFR>60 mL/min/1.73m2 . All patients were evaluated by echocardiography and X-ray. Results Left ventricular hypertrophy (LVH) was present in 74.7% CKD patients, most frequently in CKD 4 stage and in RTR. Calcifications of abdominal aorta (CAA) were present in 87% CKD 4, 60% RTR and in 44% CKD 3 patients. Calcifications of the mitral valve were found in 34.2% CKD 4, 25.0% RTR and in 6.7% CKD 3 stage patients. Aortic valve calcifications were most frequently present in CKD 4 stage (26.3%). The LV mass index negatively correlated with eGFR (p<0.001), and positively with parathyroid hormone (p<0.001), phosphorus (p=0.043), age (p<0.001) and diabetes (p=0.043). In multivariate regression analysis the risk factor for calcifications of the mitral and aortic valve, as well as for CAA was the decline in eGFR (p<0.001). Conclusion Renal transplant recipients have a higher incidence of CV remodelling than patients with CKD 3 and less than patients with CKD 4 stage, indicating incomplete regression of CV calcifications and LVH after kidney transplantation. A decrease of renal function represents a significant risk factor for valvular and vascular calcifications occurrence in CKD patients.

This study argues that the shift to open business models relies on aligning value-creation and value-capture activities through interactive processes that involve both provider and customer. Yet, l...

Today's grapevine assortment in Bosnia and Herzegovina is the result of several evolutionary, agroecological and historical factors. One of them is the proximity of Dalmatia as a wine-growing area, from which some cultivars were transferred and adapted to the breeding conditions of Bosnia and Herzegovina. Over the course of time, cultivars migrated from one area to another. As a result, some cultivars retained the same name in both production areas, while others were given another name. Within the program of collection and maintenance of autochthonous grape cultivars in Bosnia and Herzegovina, more than 35 genotypes were collected. For reliable grapevine germplasm characterization and identification, genetic analysis of nine standard microsatellite loci was performed. Based on the microsatellite profiles obtained, cluster analysis was carried out and mutual relations were represented by a UPGMA dendrogram. Several synonyms and homonyms have been identified among the analyzed genotypes. Comparison of genetic profiles from Bosnia and Herzegovina and Croatia also identified synonyms and homonyms within these two groups, and confirmed strong connections with the Dalmatian wine-growing region.

Abstract This paper elaborates the concept of the renewable district heating system (DHS) in Municipality of Visoko, Bosnia and Herzegovina, as part of the CoolHeating project funded by the EU’s Horizon 2020 programme, which is going to be integrated into the planned DHS supplied by a combined heat and power facility (CHP). Forecast of the demand, type and capacities of the production units, as well as optimization of the production plan, was performed by the software EnergyPRO. Calculations are based on inputs such as climate conditions, connection rate for housing facilities, prices of all energy sources, energy efficiency performance of the facilities, temperature level of DHS, heat losses, investment costs, operating costs such as maintenance costs, fuel and electricity prices, taxes, subsidies and finally operating time, while the period for the optimization was calculated per hour throughout the year. The overall approach leads to a flexible modular DHS solution based on RES and CHP. Much better economic and environmental sustainability indicators, demonstrated on real inputs of the Visoko project, have been noticed as opposed to the existing heating solution. Similar concepts can be developed for other communities to ensure replication and thus multiply the effects and contribution to sustainable development.

Introduction: Hyperparathyroidism is a common endocrine disorder with potential complications of bone, renal, neurocognitive and cardiovascular system. Aim: To determine the correlation between the size of parathyroid glands and parathormone values in the patients with hyperparathyroidism. Methods: We analyzed a retrospective-prospective database of 79 consecutive patients who underwent parathyroidectomy for hyperparathyroidism at our institution between January 2011 and February 2018. The values of parathormone, calcium and phosphorus were determined in all patients before and after surgery. Ultrasonography were performed before surgery. Imaging results were confirmed by pathology. We analyzed the correlation between the sizes parathyroid glands obtained trough ultrasonography and pathology with parathormone values. Results: The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. Our study demonstrated that between actual glands sizes (volumes), expresses in millimeters, measured on pathohistological analysis and ultrasound examination and size value of parathormone its increased value does not affect the size of the gland. We investigate the correlation between the size of glands measured according to the pathohistological finding and the value of parathormone we obtained the correlation results close to the statistical features. The correlation value of parathormone and glands sizes according to the pathohistological finding measured trough the determined assessment scale we determined the statistically important of medium value. Conclusion: One of the important factors for parathyroidectomy is the value of parathormone. Serum parathormone level might be predictable by a total size of parathyroid glands and could be an effective the predictor of gland localisation.

INTRODUCTION As non-carious cervical lesions (NCCLs) may compromise aesthetics and function, knowledge of their aetiological covariables enhances management of clinical complaints and success of restorative treatments. AIMS The primary aim of this study was to assess the presence of NCCLs among the general population of the Republic of Srpska, Bosnia and Herzegovina and the potential association with patient-related risk factors. METHODS A prevalence study of NCCLs included 738 respondents from eight towns/municipalities. Two dental practitioners examined all respondents. NCCLs were diagnosed according to the Smith and Knight tooth wear index, measured using a Williams periodontal probe. Data regarding risk factors were obtained through a structured questionnaire. Multivariate logistic regression was used to analyse the association of risk factors and the occurrence of NCCLs. RESULTS Non-carious cervical lesions were diagnosed in 384 (52%) respondents. Multivariate regression analysis showed that several variables were independently associated with the risk of developing NCCLs, including frequent consumption of acid food (P = 0.001), frequent consumption of acid drinks (P = 0.001), retaining drink in the mouth (P = 0.001), alcohol consumption (P = 0.030), bruxism (P = 0.018) and gastro-oesophageal reflux (P = 0.023). First mandibular premolars were the most affected teeth (left: 46.0%; right: 44.0%), followed by the second right maxillary premolars (37.3%), second left maxillary premolars (33.6%) and finally by the first right maxillary premolars (34.0%). CONCLUSION The results of the current study suggest that NCCLs occur frequently and have a multifactorial aetiology. The lowest prevalence was recorded among individuals younger than 20 years of age. As the majority of risk factors are modifiable, regular dental care could lead to the early detection of NCCLs.

Aim To systematically review the scientific evidence of biomarker validity, reliability, specificity and sensitivity in identifying malnutrition in the elderly. Methods Peer-reviewed journals were searched using PUBMED and EBSCO from January 1998 to April 2018. The articles included description of the association between malnutrition blood biomarkers and validated nutritional status assessment instruments and studies were conducted among community-dwelling elderly or nursing home residents. Results The research strategy identified a total of 293 studies. This literature review picked out seven articles for follow-up evaluation. A total of sixteen blood biomarkers were identified. Six studies found a significant association between the nutritional assessment score and albumin level. Conclusion Combining serum concentrations of malnutrition biomarkers with nutritional status assessment tools has a great potential in identifying the risk of malnutrition in the elderly, while also increasing sensitivity and specificity.

Aim To develop and validate a screening questionnaire for migraine without aura with sufficient diagnostic accuracy to be used in primary care settings. Methods The study was designed as cross-sectional, multicentric, diagnostic accuracy trial of new questionnaire for screening patients who visit general practitioners, with an aim to reveal migraine without aura. The instrument was constructed for the purpose of this study, and validated on the sample of 429 primary care outpatients. The gold standard of diagnosing migraine without aura was clinical estimate by a neurologist based on the International Classification of Headache Disorders 3rd edition (ICHD-III) criteria. Diagnostic accuracy of the instrument was tested through construction of the Receiver Operator Curve. Results The Balkan Migraine Screening Questionnaire (BMSQ) instrument showed good diagnostic accuracy (sensitivity 83.4% and specificity 79.9%) for migraine without aura, with significant screening yield among previously undiagnosed patients of 75.9%. The study also confirmed a high percentage of patients with hidden migraine without aura (MWA) (52.9%) revealed by the BMSQ and the ICHD-III criteria that would otherwise remain undiagnosed. Conclusion The BMSQ is a valid and reliable clinical instrument for revealing migraine without aura, which could be easily selfadministered by patients. It has high screening yield, discovering majority of patients with previously undiagnosed migraine without aura, whose definite diagnosis should later on be confirmed by the attending physicians using the ICHD-III criteria.

OBJECTIVE To investigate the level and causes of stress and the risk of onset of burnout syndrome among physicians employed at the Primary Health Care Centre, Banja Luka. SUBJECTS AND METHODS Between March 1, 2018, and May 31, 2018 all physicians from the Primary Health Care Centre, Banja Luka were offered the following questionnaires to fill in: a socio-demographic questionnaire, a questionnaire for self-assessment of the level of stress and the Maslach Burnout Inventory for assessment of the risk of burnout syndrome. RESULTS Out of 211 physicians, 85.8% were female. A high level of stress was found in 77.7% of the subjects. Older doctors had higher levels of emotional exhaustion compared to younger doctors with a shorter length of service (r=0.236, P=0.01). Emotional exhaustion was significantly correlated with a high level of depersonalization, a low level of personal accomplishment and a high level of stress (r=0.380, r=-0.174 and r=0.574, P=0.01, P=0.04 and P<0.01, respectively). Depersonalization correlated with a low level of personal accomplishment and stress (r=-0.347 and r=0.283, P<0.01 and P=0.01, respectively), while the level of personal accomplishment was in a negative correlation with stress (r=-0.281, P=0.01). A high stress level was associated with a high degree of emotional exhaustion (OR 56.543; 95% CI 11.35-213.09; P<0.001) as well as lack of personal accomplishment (OR 0.155; 95% CI 0.04-0.50; P=0.003). CONCLUSION A high level of stress was associated with older age, female gender, as well as with a high degree of emotional exhaustion and a lack of personal accomplishment. Preventive measures are warranted.

Aim To determine the prevalence of depressive episodes and recurrent depressive disorders despite of the length of therapy and type of antidepressants. Methods The study was conducted among 508 patients aged 19-65 years who were treated for depression for at least 3 months (mild and moderate episodes were controlled and the effects of treatment monitored by family physicians, while severe episodes were controlled by a psychiatrist) during 2013- 2015 in Zenica-Doboj Canton using the Hamilton Depression Rating Scale (HDRS). Results The average age of the patients was 48.98±11.585 years. Depressive disorder was most commonly represented in patients with high-level education, 22%, more frequently in non-productive workers (non-productive vs. manufacturing 58%:35%). A significant number of patients who were treated for depression were unemployed (57%). All respondents were suffering from the most serious episode of depression with an average depression rate at the Hamilton scale 18.49±8.603, with a very serious depression level of 32%, severe 17%, moderate 21%, and mild 20%. Most patients were treated with paroxetine, 27%, fluoxetine 22% and sertraline 17%. Efficacy of depression treatment with different types of selective serotonin reuptake inhibitors antidepressants (SSRIs) was not significantly different (p=0.502). Conclusion Success of the treatment with the absence of symptoms of depression was achieved in 10% and the maintenance of depressive episodes occurred in 90% of cases. Adverse reactions with the most commonly prescribed SSRI in our country should be important in creating procedures and strategies for the future treatment of depression in family medicine.

Aim To explore the experiences of anaesthesia nurses in assessing postoperative pain in patients undergoing total hip and/or knee arthroplasty. Methods Data were collected through four focus group interviews (FGI) using the critical incident technique (CIT). The participants were six men and 12 women, all registered nurses with further education in anaesthesia with at least five-year experience of caring for patients on a postoperative ward. Results Maintaining communication with orthopaedic patients, different ways to assess pain, the assessment of unresponsive patients, using pain assessment scales and different work circumstances influencing their use, were stated as the main problems the nurses emphasize while assessing the pain of patients. Conclusion Skills related to observing the behaviour and experience of pain in different individuals are needed to ensure an understanding of patients' pain, as well as the patients' ability to estimate their pain, where the intensity of the pain varies in different patients. Further studies are needed to examine the way health professionals assess pain, depending on the patients' ability to transform their pain from a subjective feeling into an objective numeric grade. The way individuals assess their pain differently and the way the resulting knowledge and experience of postoperative care may help nurses and other health-care professionals.

Aim To examine the effects of therapeutic hypothermia on the outcome of patients with the diagnosis of out-of-hospital cardiac arrest (OHCA). Methods The study included 76 patients who were hospitalised at the Medical Intensive Care Unit (MICU) of the Clinical Centre University of Sarajevo, with the diagnosis of out-of-hospital cardiac arrest, following the return of spontaneous circulation. Therapeutic hypothermia was performed with an average temperature of 33oC (32.3 - 34.1o C) on the patients who had coma, according to the Glasgow Coma Scale (GCS). Results Multiple organ dysfunction syndrome (MODS) significantly affected survival (p=0.0001), as its presence reduced patients' survival by 96%. In addition, ventricular fibrillation (VF) as the presenting rhythm, also significantly affected survival (p=0.019). A degree of patient's coma, as measured by the GCS, significantly affected survival (p=0.011). For each increasing point on the GCS, the chance for survival increased twice. Moreover, other physiological factors such as the pH and the lactate serum levels significantly affected patients' survival (p=0.012 and p=0.01, respectively). Conclusion In patients with the diagnosis of OHCA who underwent to the treatment with therapeutic hypothermia, verified VF as a presenting rhythm was a positive predictive factor for their outcome. Therefore, therapeutic hypothermia represents an option of therapeutic modality for this type of patients.

Introduction: Knowledge of the size of surfaces available for transport is important for assessing the amount of nutrients that can be transmitted to the fetus for its normal growth and development. Aim: The aim of our study, was to determine the stereological structural parameters of the parenchymal part of placenta, ratio of birth weight and placental weight, and to determine their correlation with the body length and head circumference of the newborns of adolescent pregnant women. Methods: The study was conducted on a total of 60 human placentas of term pregnancy, divided into two groups according to the age of pregnant women. The experimental group consisted of 30 placenta of pregnant women aged 13-19. The control group consisted of 30 placenta of pregnant women aged 20-35. Computer assisted morphological analysis of images of histological preparations using stereological methods was performed. Results: Surface density of terminal villi of adolescent placentas is significant higher than the control group (t = 14,179, df = 29, p <0,0001). The T-test (t = -5,868, df = 29, p <0,0001) showed statistically significant difference in the surface density of fibrinoid in two compared groups. T-test (t = 6.438, df = 29, p <0.0001) found that total surface of terminal villi was significantly higher in adolescent placentas. The T-test (t = -6,747, df = 29, p <0,0001) found that total surface of fibrinoid was significantly lower in adolescent group. The T-test (t = 4.203, df = 29, p <0.0001) found that the ratio of birth weight of newborn and adolescent placental weight was significantly higher in relation to the control group. Conclusion: Adolescent placentas was more efficient in increasing the weight of newborns, compared to the control group placentas.