Background. Endoscopic Retrograde Cholangiopancreatography (ERCP) is an essential procedure for diagnosing and treating biliary and pancreatic disorders but carries the risk of significant complications, particularly in patients with pre-existing conditions. The most critical complications include acute pancreatitis, bleeding, perforation, and cholangitis. Early detection and comprehensive therapeutic interventions are key factors in patient recovery and require seamless communication among healthcare professionals at all levels of care. Close collaboration between medical staff ensures a well-coordinated treatment strategy, even at the primary care level. Objective: This article aims to present a case of a patient who developed multiple severe complications following ERCP, including ulcer perforation with pneumoperitoneum, acute pancreatitis, cholangitis, and cardiac decompensation, all of which were successfully managed within an outpatient and family medicine setting. Methods and Design: The patient’s clinical history, laboratory findings, radiological imaging, and endoscopic evaluations were carefully analyzed and described to outline the approach to diagnosis and management. Case Presentation: An 86-year-old male with a known history of peptic ulcer disease opted for outpatient treatment after undergoing an ERCP procedure. The patient subsequently developed a series of severe complications, including ulcer perforation, pneumoperitoneum, acute pancreatitis, and cholangitis, along with cardiac decompensation. However, through meticulous outpatient management and primary care follow-up, the patient achieved a favorable recovery. Conclusion: This case report highlights that comprehensive outpatient management can effectively address complex complications following ERCP, even in patients with pre-existing conditions. Coordinated care at the primary healthcare level plays a vital role in ensuring positive outcomes.

Background/Aim: Dental fear and anxiety (DFA) are psychological phenomena normally arising and developed in the dental office during various kinds of dental procedures and interventions. The most usual stressors for the DFA appearance are those related to dental pain, no matter if the pain has already been caused, or potentially will be committed. There are a few main dental pain-provoking factors related to endangering body integrity in the oral cavity, and tooth extraction is the strongest one. The research aimed to observe, notify, and analyze physiological parameters of DFA in adults related to oral surgical therapy procedures of removing impacted third permanent molars. Material and Methods: After inclusive selection 500 patients entered into the study. The study protocol included preoperative assessment of DFA presence with Corah's Dental Anxiety Scale (CDAS) on examination day, preoperative assessment of physiological parameters on examination day and operative day before the treatment, as well as their postoperative assessment followed by evaluation of postoperative pain, on the day after the treatment. Results: The results of our research indicated that an increase in DFA led to increased values of the measured physiological parameters for all preoperative measurement days. The postoperative decrease in the physiological parameters values could be explained by the fact that the oral-surgical procedure was completed, so the psychological burden of the patients was also less. Conclusions: Patients with higher values of the DFA presence have also declared more postoperative pain.

Background: Cholelithiasis is one of the most common issues affecting the gastrointestinal tract. The prevalence of cholelithiasis ranges from 11% to 36%. The prevalence is found to be associated with a number of factors including age, gender and ethnicity. Women have three times higher risk of developing this condition in comparison to men. Objective: This The aim of this study is to prove that occurrence of early and late postoperative complications is lower in patients who had three metal clips placed on cystic artery and ductus cysticus in comparison to the patients who had two metal clips placed. Methods: In this retrospective study we included all the patients who underwent acute laparoscopic cholecystectomy between January 1st 2021 and December 31st 2022 at the Department of Abdominal Surgery of University Clinical Centre Tuzla. Total number of patients included in the study is 148. A total of 1200 laparoscopic cholecystectomies were performed, of which 1052 patients had chronic calculus cholecystitis, and the performed laparoscopic cholecystectomies were part of elective surgical procedures. Remaining 148 patients had acute calculus cholecystitis, and were admitted and operated laparoscopically in an emergency protocol. Results:: Out of total amount of 82 laparoscopic surgeries were performed with the placement of two clips on the cystic artery and cystic duct, and 66 laparoscopic cholecystectomies with the placement of three clips on the cystic artery and cystic duct. Out of a total of 82 patients who were implanted with two clips, 6 of them had some of the postoperative complications. In the group of patients who had three clips implanted, none of the 66 subjects had any postoperative complications. Conclusion:: The study confirms that patients who underwent placement of three clips had lesser odds of developing complications, and that this occurrence is not accidental but rather a consequence of the choice of the surgical method.

Working with various tools is demanding and can also be very dangerous. Many standards regulate this area, including ISO 45001:2018. Workplace injuries and illnesses significantly burden employers and impact the economy in general, which has led to the development of this important standard. Additionally, many companies have internal work instructions for using specific tools to protect the health and lives of individuals. Forklifts are such tools that require personnel to be trained in their operation to ensure the protection of themselves and others. This paper presents the operational instructions for handling forklifts at the Zenica Steelworks, which have been in place for a considerable period and can serve as a model for other manufacturing or service companies.

Introduction: Breast cancer, the most common malignancy in women, represents a significant health issue, and biomarkers such as the Ki-67 index and uPA/PAI-1 complex can provide insight into treatment outcomes and therapeutic response. Objective: The primary outcome of the study was the assessment of 5-year disease-free survival (DFS), defined as the postoperative period until the occurrence of loco-regional or distant metastases and death from any cause. Patients and Methods: A retrospective cohort study included 166 patients with early invasive breast cancer, in whom the prognostic and predictive significance of the uPA/PAI-1 complex and Ki-67 biomarkers in surgically treated patients at the Clinic for General and Abdominal Surgery of the University Clinical Center in Sarajevo was evaluated during the period from September 2015 to February 2017. Results: Univariate regression analysis identified an increased probability of DFS shorter than five years in patients with negative hormone receptors, positive HER-2 receptor, ≥ 8 positively mph nodes, and a Ki-67 index ≥ 14% (p < 0.05). Multivariate regression analysis revealed that T2 stage, tumor size of 20-50 mm, and a Ki-67 index ≥ 14% were associated with a higher probability of DFS shorter than five years (p < 0.05). The five-year DFS rate was higher in patients with a Ki-67 index < 14% compared to those with ≥ 14% (p = 0.011), while there was no difference in five-year DFS among patients with different levels of the uPA/PAI-1 complex (p = 0.636). Conclusion: Our study highlights the importance of the Ki-67 proliferative index as a strong prognostic and predictive factor for DFS in patients operated on for early invasive breast cancer. Additional monitoring and tailored therapeutic strategies may be beneficial in patients with elevated Ki-67 index values, T2 stage, and tumor size of 20-50 mm.

Introduction: Colorectal cancer (CRC) is one of the most common malignancies with significant global health and economic implications. Genetic mutations in genes such as TP53, APC, KRAS, and MMR play a crucial role in the development and progression of this cancer. This review paper analyzes current knowledge about the impact of these mutations on colorectal carcinogenesis, using available literature. Objective: To provide a comprehensive review of the role of genetic mutations in TP53, APC, KRAS, and MMR genes in the development of colorectal cancer and to consider their impact on diagnosis and treatment. Materials and Methods: This review examines peer-reviewed research articles and reports sourced from databases such as PubMed, Google Scholar, and other academic sources. The focus was on studies investigating genetic mutations, their prevalence, and their role in the pathogenesis of CRC. Results: Mutations in the TP53 gene, present in more than 50% of CRC cases, are critical for malignant cell transformations. KRAS mutations, found in about 50% of cases, lead to abnormal signaling contributing to unchecked proliferation. APC mutations are associated with hereditary predisposition to CRC, while MMR genes, such as MLH1 and MSH2, play a key role in DNA repair and are linked to hereditary nonpolyposis colorectal cancer. Conclusion: Genetic mutations in TP53, APC, KRAS, and MMR genes play a significant role in the development of colorectal cancer. A deeper understanding of these mutations may significantly enhance diagnostic and therapeutic strategies, guiding future research in this rapidly evolving field.

Background: Nasal decongestants are drugs that are used to prevent excessive nasal secretions, and to facilitate breathing in case of a cold, allergy or other disorders of the upper respiratory tract. They are most often used locally in the form of sprays, nasal drops or inhalation products, but they can also be used oraly in the form of tablets or capsules, alone or in combination with other medicines. Monitoring the consumption of medicines is important for the analysis and improvement of its rational use, and the aim of this paper is to analyze the outpatient consumption of nasal decongestants for local administration, in the Republic of Srpska during the period from 2020 to 2022. Methods and Objectives: The data were obtained from the Annually Drug Consumption Report of the Public Health Institute of the Republic of Srpska, and are expressed in defined daily doses per 1000 inhabitants per day (DID), in accordance with the recommendations and classifications of the World Health Organization. Results: Among the drugs for the treatment of the respiratory tract, nasal preparations (drugs for the treatment of diseases of the nasal mucosa) are in second place, right after the drugs for the treatment of obstructive lung diseases. Among the nasal preparations, the sympathomimetics xylometazoline and oxymetazoline, and the combination of xylometazoline with dexpanthenol, are used the most, similarly to other countries in the region. Conclusions: During the observed period, a slight increase in the consumption of nasal preparations was observed, and it is necessary to continue monitoring the trend of consumption and work on improving cooperation between doctors, pharmacists and patients in order to rationalize therapy and raise knowledge and awareness about the correct use of nasal decongestants in accordance with modern therapeutic guidelines.

Background: Patulin (4-hydroxy-4H-furo[3,2-c]pyran-2(6H)-one; CAS Number 149-29-1) patulin as a secondary metabolite of certain types of molds, primarily Penicillium, Aspergillus and Byssochlamys, belongs to the group of mycotoxins. Patulin is a well-known toxicant in food, with adverse immunological, neurological and gastrointestinal outcomes associated with chronic intake. Patulin is an enteropathogenic mycotoxin and has the ability to alter the function of the intestine. Methods and Objectives: The method for determining patulin using liquid chromatography is described in AOAC method 995.10, by which patulin is extracted three times with ethyl acetate, followed by purification using sodium carbonate solution, evaporation of the organic solvent, and determination of patulin on a C-18 reverse phase column, with a UV detector. 24 samples of baby food containing apple were analyzed. All samples were imported. Results: In the group of products for infants and small children, patulin was detected in juices and porridges, in average concentrations below 10mg/kg. The maximum determined content of patulin was 3.3 and 2.7 mg/kg in juices and porridges, respectively. In none of the 24 samples of food for infants and young children tested in this research, the patulin content was not over 10 mg/kg, from which it follows that all tested samples in terms of patulin content meet the legal requirements. Conclusions: The safety rating of the tested samples was given on the basis of a comparison of the obtained results with the relevant maximum permitted levels defined by the legislation in the Republic of Srpska. In order to preserve public health, it is necessary to monitor and control the population's exposure to patulin.

Background: In aim to promote HPV vaccination among children and youth, the Institute for Public Health of the Federation of BiH in 2023 developed an HPV immunization program, furtherly accepted by the Federal Ministry of Health. In collaboration with WHO and UNFPA country offices, the Institute for Public Health of the Federation of BiH initiated education to emphasize the importance of improving the knowledge and skills for over 280 health professionals in effective communication with parents in the promotion of HPV vaccination. Methods and materials: Paper presents an analysis of results of the pre and post testing of the health professionals directly involved in the HPV vaccination process in the Federation of BiH, regarding their self-confidence in communication with parents about HPV vaccination. For data collection was used the questionnaire as a part of the WHO document "Communicating with caregivers about HPV vaccination: facilitator's guide" published in 2023. The questionnaire was created in Google Forms for health professionals who participated on training. For descriptive and inferential statistics of collected data used IBM SPSS20 package. Results: The data showed an increase in self-confidence of health professionals in communication with parents after completed training. Before training 32.5% of health professionals confirmed self-confidence in talking to parents about HPV vaccination while 68.0% of them after training. Self-confidence about adverse reactions after HPV vaccination is confirmed by 27.4% health professionals before training and by 64.4% of them after training. Conclusions: A systematic approach in improving the communication knowledge and skills of health professionals is significant support for increasement of the coverage and promotion of HPV vaccination.

Sage has been used in traditional medicine to prevent and treat many health problems. This study aimed to determine and compare the phytochemical composition and antioxidative activity of sage leaf extracts obtained with 50% methanol (50MSE) and 80% methanol (80MSE). We determined the total phenolic content (TPC), total tannin content (TTC), and total flavonoid content (TFC) in extracts. Terpenoids were identified using gas chromatography-mass spectrometry (GC–MS), and the radical scavenging capacity of extracts was measured using DPPH assay. TPC was higher in 80MSE, TTC was higher in 50MSE, and TFC did not differ. GC–MS analysis showed that the content of α-thujone and L-camphor was low in both extracts, with higher content in 50MSE. DPPH assay indicated that a slightly lower IC50 value and higher antioxidant potential had 80MSE. Results pointed out that the polarity of the solvent and water content had different effects on the extraction of polyphenols and terpenoids.

The safety of drinking water is crucial for public health. Industrial and human activities have increased the use of heavy metals (cobalt, nickel, manganese) in water sources. These non-biodegradable, potentially carcinogenic metals pose serious health risks in drinking water. This study developed an efficient aqueous biphasic system (ABS) for removing these metals using real drinking water samples. Two ionic liquids, tetrabutylphosphonium DTPA ([TBP][DTPA]) and tetrabutylphosphonium acetate ([TBP][Ac]), were selected as ABS components, with ammonium sulfate as the salting-out agent. Phase diagrams were established, and extraction efficiencies were evaluated. The [TBP][DTPA] IL demonstrated superior performance, achieving over 95% extraction efficiency for all metals due to the stable complex formation with metal ions. The ABS proved highly effective for real samples, making it a promising approach for ensuring safe drinking water.

This study investigates tetrabutylphosphonium-based ionic liquids for food dye removal via extraction using aqueous biphasic systems with ammonium sulfate. Furthermore, these ionic liquids were used for activated carbon regeneration and employed for dye removal from the water as well. This dual approach achieved high extraction efficiencies (≈ 90%) and nearly complete regeneration (98%) of the activated carbon used as a food dye adsorbent. These findings underscore the potential of tetrabutylphosphonium ionic liquids for managing dye-contaminated water.

The casting industry uses large quantities of quartz sand, which is a cheap and accessible raw material that must be prepared for use in foundries. After the casting process, foundries generate huge amounts of waste foundry sand (WFS) as industrial waste. The regeneration and reuse of waste foundry sand is a practice and a necessity in many foundries for technological, environmental, and economic reasons. In this review paper, in addition to the characteristics of quartz sand for the casting industry and the characteristics of WFS, typical processes of regeneration in industrial practice, as well as the possibilities of using such recycled WFS in other industries, are presented.