Introduction: The most common cause of intracranial bleeding in younger patients and children are vascular anomalies. Digital subtractions angiography presents a gold standard in diagnostics of aneurisms and vascular malformations. Our aim is to present our experience in using computed tomography angiography in diagnosing arteriovenous malformations. Methods: We included 150 patients with acute non-traumatic intracranial hemorrhage diagnosed by non-contrast CT examination, after which they were subjected to CT angiography of the cerebral vessels, and then underwent maximum intense projection and volume rendering reconstruction. Results:  Out of 150 patients with non-traumatic intracranial hemorrhage, in 121 (81%) a diagnosis of  aneurysm was rendered, while in 8 (5%) arteriovenous malformation was found. In 29 (14%) patients cause of bleeding was not identified. Patients with arteriovenous malformations, were age 17-77 years, with mean age 42.75 years. Five (62.5%) of them were female patients and three (37.5%) were male. Conclusion: Spontaneous non-traumatic intracranial hemorrhage is a significant cause of morbidity and mortality. Computed tomography angiography is sufficiently specific and sensitive in diagnosis of arteriovenous malformations in our experience.

Background: Treatment of nonculprit coronary stenosis during primary percutaneous coronary intervention in patients with ST‐segment elevation myocardial infarction may be beneficial, but the mode and timing of the intervention are still controversial. The aim of this study was to examine the significance and prognostic value of preserved coronary flow velocity reserve (CFVR) in patients with nonculprit intermediate stenosis early after primary percutaneous coronary intervention. Methods: Two hundred thirty patients with remaining intermediate (50%–70%) stenosis of non‐infarct‐related arteries, in whom CFVR was performed within 7 days after primary percutaneous coronary intervention, were prospectively enrolled. Twenty patients with reduced CFVR and positive results on stress echocardiography or impaired fractional flow reserve underwent revascularization and were not included in further analysis. The final study population of 210 patients (mean age, 58 ± 10 years; 162 men) was divided into two groups on the basis of CFVR: group 1, CFVR > 2 (n = 174), and group 2, CFVR ≤ 2 (n = 36). Cardiac death, nonfatal myocardial infarction, and revascularization of the evaluated vessel were considered adverse events. Results: Mean follow‐up duration was 47 ± 16 months. Mean CFVR for the whole group was 2.36 ± 0.40. There were six adverse events (3.4%) related to the nonculprit coronary artery in group 1, including one cardiac death, one ST‐segment elevation myocardial infarction, and four revascularizations. In group 2, there were 30 adverse events (83.3%, P < .001 vs group 1), including two cardiac deaths, two ST‐segment elevation myocardial infarctions, and 26 revascularizations. Conclusions: In patients with CFVR > 2 of the intermediate nonculprit coronary lesion, deferral of revascularization is safe and associated with excellent long‐term clinical outcomes. HIGHLIGHTSTDE CFVR provides useful information on the functional status of coronary arteries.We performed TDE CFVR of the intermediate (50%‐70%) nonculprit coronary stenosis.TDE CFVR > 2 is associated with excellent long‐term clinical outcomes.Findings contribute to ongoing debate over the best management of nonculprit lesions.

Introduction: The influence and interactions of various genetic, hormonal, environmental and nutritional factors and risks for decreased bone mineral density in older age are not yet clear. The aim of this study was to examine relationship between reduced exposure to estrogen over a lifetime (early age at menopause, shorter period between menarche and menopause) and bone mineral density in older women. Methods: A total of 60 women, aged 60-75 years were included and assigned to osteoporosis group (n=30), or control group with normal bone mineral density or osteopenia (n=30). The values ​​of bone mineral density were obtained by dual energy X-ray absorptiometry (DXA) at the lumbar spine (L2-L4) and proximal femur. Results: Women with osteoporosis entered the menopause at a younger age (43.03±3.18 years) compared to women without osteoporosis (51.93± 2.30 years) and the difference was statistically significant, p=0.0001. In addition, women with osteoporosis had shorter timespan between menarche and menopause (28.33±3.31 years), compared to women without osteoporosis (38.43±2.48 years), which was statistically significant, p=0.0001. Conclusion: Reduced exposure to estrogen over a lifetime because of early menopause, and shorter timespan between menarche and menopause may be associated with decreased bone mineral density and osteoporosis in postmenopausal women.

Objetivo: Classificar usuarias de anticoncepcionais hormonais injetaveis (AHI) quanto ao uso seguro segundo os criterios medicos de elegibilidade da Oraganizacao Mundial da Saude (OMS) e verificar a associacao entre tipo de injetavel e tempo de uso com o uso seguro. Metodos: Estudo transversal, descritivo e exploratorio. A populacao foi composta pelas 52 usuarias de AHI. Os dados foram coletados por meio de entrevista, que seguiu formulario elaborado pelas autoras, sendo identificado fatores que contraindicassem ou indicassem o uso do metodo, classificando-as em categorias de 1 a 4. O Projeto foi aprovado pelo Comite de etica e pesquisa da Universidade Federal do Ceara, CAEE:36668314.3.0000.5054. Resultados:Foram identificadas 44 (84,7%) mulheres em uso seguro e 8 (15,3%) inseguro. Usuarias ha mais de um ano tiveram uma frequencia maior de uso inseguro (p=0,001). Conclusao: Seguir as recomendacoes da OMS deve ser rotina nas cosultas de enfermagem visando a protecao e seguranca da mulher.

Introduction: The most common health problem associated with the negative effect of heavy school bags is back pain, and non-specific back pain is frequently observed in childhood. The prevalence of back pain in schoolchildren varies from 12% to 92%, depending on the age and affected region of the back. To prevent the occurrence of back pain in schoolchildren, the weight of school bag should not exceed 10% of the child’s body mass.Methods: This was a descriptive, cross-sectional study conducted in April 2017. We included 79 students of the fifth and sixth grade from the elementary school in Sarajevo. Information on the weight and type of school bag, method of carrying a school bag, and feelings of pain and tiredness due to school bag were obtained by questionnaire.Results: In the total sample, the majority of the students (64.6%) reported occasional back pain while carrying the bag, 20.3% of students reported no back pain, and 11.4% of students experienced frequent back pain. The mean school bag weight in the fifth grade was 4.01 ± 0.57 kg, and it was significantly higher (4.61 ± 0.86 kg) in the sixth grade. About 48.5% of the students in the fifth and 50% in the sixth grade carried school bags weighing more than 10% of the body mass. A higher mean weight of school bag was significantly more frequent in students who reported always feeling tired (11.03 ± 2.74%) compared to those who did not feel tired while carrying the school bag (8.41 ± 2%).Conclusions: Overall, more frequent occurrence of back pain and tiredness in schoolchildren was associated with heavier school bags (>10% of the body mass), and the occurrence of back pain due to school bag was related to gender (i.e., back pain was more common in girls compared to boys).

Objective: To determine the incidence of systemic inflammatory response of the organism in surgical patients and its impact on the outcome of treatment. Methods: A prospective study was conducted on 60 patients undergoing abdominal surgical procedures, between January 2014 and December 2015 in the Surgery Clinic at the University Clinical Center Tuzla. Two groups of thirty were formed by the method of consecutive sampling. The first group consisted of subjects who were prepared for elective abdominal surgery (laparoscopic cholecystectomy), and the second group subjects underwent an emergency surgery due to acute abdomen (laparoscopic cholecystectomy). Results The body temperature difference was statistically significant between the two investigated groups in all stages (c2: t0=3,486; t1=3,098; t2=2,453, t: t0=-11,210; t1=-7,360; t2=-4,927, p < 0,05). Non-elective surgery group had a statistical significant difference of the heart rate at all stages (c2: t0=3,873; t1=3,357; t2=3,227, t: t0=-16,524; t1=-10,407; t2=-9,842, p < 0,05). There is a statistically significant difference in the pCO2 values in all stages between groups (c2: t0=2,582; t1=1,678; t2=1,162, t: t0=4,323; t1=2,653; t2=2,229, p < 0,05). The SIRS score has a good positive correlation with the length of treatment, while the correlation with the outcome of treatment has no statistical significance. Conclusion Inflammation scores monitoring in surgical patients is important for the surgical treatment success analysis. By modifying the therapy and influencing the inflammatory response, the results of treatment are improved.

Objective To explore family physicians' attitudes, previous experience and self-assessed preparedness to respond or to assist in mass casualty incidents in Croatia. Methods The cross-sectional survey was carried out during January 2017. Study participants were recruited through a Facebook group that brings together family physicians from Croatia. They were asked to complete the questionnaire, which was distributed via google.docs. Knowledge and attitudes toward disaster preparedness were evaluated by 18 questions. Analysis of variance, Student t test and Kruskal-Wallis test t were used for statistical analysis. Results Risk awareness of disasters was high among respondents (M = 4.89, SD=0.450). Only 16.4 of respondents have participated in the management of disaster at the scene. The majority (73.8%) of physicians have not been participating in any educational activity dealing with disaster over the past two years. Family physicians believed they are not well prepared to participate in national (M = 3.02, SD=0.856) and local community emergency response system for disaster (M = 3.16, SD=1.119). Male physicians scored higher preparedness to participate in national emergency response system for disaster (p=0.012), to carry out accepted triage principles used in the disaster situation (p=0.003) and recognize differences in health assessments indicating potential exposure to specific agents (p=0,001) compared to their female colleagues. Conclusion Croatian primary healthcare system attracts many young physicians, who can be an important part of disaster and emergency management. However, the lack of experience despite a high motivation indicates a need for inclusion of disaster medicine training during undergraduate studies and annual educational activities.

The article discusses the reception and circulation of programmed instruction at the Universidade Federal de Minas Gerais as an example of the appropriation of behavioral analysis in Brazil and sheds light on part of this appropriation in the 1960s and 1970s in the context of Brazil's higher education reform and of US social and intellectual influence. Results indicate that the indigenization of programmed instruction involved its circulation as an educational resource that emphasized the student's role and his autonomy from the teacher. Sources point to clashes that derived from preconceptions about both the teaching-learning process and US influence, key elements to understand the reception and circulation of programmed instruction in Brazil.