The Sustainable Development Goals are far off track. The convergence of global threats such as climate change, conflict and the lasting effects of the COVID-19 pandemic-among others-call for better data and research evidence that can account for the complex interactions between these threats. In the time of polycrisis, global and national-level data and research evidence must address complexity. Viewed through the lens of 'systemic risk', there is a need for data and research evidence that is sufficiently representative of the multiple interdependencies of global threats. Instead, current global published literature seems to be dominated by correlational, descriptive studies that are unable to account for complex interactions. The literature is geographically limited and rarely from countries facing severe polycrisis threats. As a result, country guidance fails to treat these threats interdependently. Applied systems thinking can offer more diverse research methods that are able to generate complex evidence. This is achievable through more participatory processes that will assist stakeholders in defining system boundaries and behaviours. Additionally, applied systems thinking can draw on known methods for hypothesising, modelling, visualising and testing complex system properties over time. Application is much needed for generating evidence at the global level and within national-level policy processes and structures.

Aim: During the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many countries reported a significant decrease in the prevalence of influenza virus cases. The study aimed to characterize the flu seasons from 2018 to 2023 in Sarajevo Canton, Bosnia and Herzegovina (B&H), and to assess the possible impact of the SARS-CoV-2 pandemic on the influenza A and B virus circulation.  Methods: The CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panels were used for the detection of influenza virus A and B, and subtyping of influenza virus A (H1pdm09 virus and H3). The data for this regis-try-based retrospective study were collected at the Clinical Centre of the University of Sarajevo, Unit for Clinical Microbiology (the laboratory that acts as a referral for the detection and characterization of influenza virus and SARS-CoV-2 in Federation B&H). Results: In the 2018/2019 and 2019/2020, an equal percentage of positive cases was recorded (148/410; 36%, and 182/504; 36%, respectively). The absence of the influenza virus was observed in 2020/2021. During 2021/2022, influenza virus was detected among 19/104 (18%) patients and slightly increased in 2022/2023 (45/269; 17%). The switch of the influenza B virus lineage was observed. Conclusion: The SARS-CoV-2 virus had an impact on the prevalence of influenza virus infection among the population of the Sarajevo Canton, B&H. Since the interactions between these two viruses are not entirely clear, awareness of a possible threat to public health is crucial.

<p><strong>Aim </strong>To determine the normative range of ultrasound dimensions for the liver, spleen and kidneys in healthy children according to gender, age, body measurements, body surface area (BSA), and the influence of ethnicity on organ size.<br /><strong>Methods </strong>The prospective study included children, ranging from full-term neonates to children aged 15, with normal ultrasonographic (US) findings of the liver, spleen and kidney and no clinical evidence of a disease. Gender, age, as well as body measurements and BSA, were determined for each child along with US measurements, and normative ranges were established.&nbsp;<br /><strong>Results </strong>US images of the liver and spleen from 372 children and 366 US images of kidneys of 366 children were included. US measurements of the liver, spleen and kidney correlated well with gender, age, body weight and height, and often differed to a greater or lesser extent from the normal range of measurements (5th to 95th percentile) reported in other studies.<br /><strong>Conclusion </strong>Our results differed slightly from other reports conducted in Europe, but larger differences compared to measurements performed on children on other continents were found. Thus, our study confirmed that ethnically appropriate and modern tables of normal ultra-sound dimensions for the liver, spleen and kidneys should be used, and that the national nomogram is justified.</p>

<p><strong>Aim </strong>To evaluate the clinical impact of corticosteroids (CS) overuse in inflammatory bowel disease (IBD) patients. Excessive use of CS could delay more efficacious treatment and may indicate poor quality of care.<br /><strong>Method </strong>This is a two-phase study that used Steroid Assessment Tool (SAT) to measure corticosteroid exposure in IBD patients. In the first phase data from 211 consecutive ambulatory patients with IBD (91 with ulcerative colitis, 115 with Crohn's disease, and five with unclassified inflammatory bowel disease) were analyzed by SAT. In the second phase, one year after data entry, clinical outcome of patients with cortico-steroids overuse was analysed.<br /><strong>Results </strong>Of the 211 IBD patients, 132 (62%) were not on corticosteroids, 45 (22%) were cortico-steroid-dependent and 34 (16%) used corticosteroids appropriately, according to the European Crohn's and Colitis Organization guidelines. In the group of patients with ulcerative colitis, 57 (63%) were not on cortico-steroids, 18 (20%) were corticosteroid-dependent, and 16 (16%) used cortico-steroids appropriate-ly; in the group of patients with Crohn's disease 70 (61%), 27 (23%) and 18 (16%), respectively. Overall, 24 (out of 45; 53%) patients with IBD could avoid the overuse of cortico-steroids if they had a timely change of the treatment, surgery or entered a clinical trial.<br /><strong>Conclusion </strong>An excessive corticosteroid use can be recognized on time using the SAT. We have proven that excessive corticosteroid use could be avoided in almost half of cases and thus the overuse of CS may indicate poor quality of care in those patients.</p>

Aim: To investigate out-of-hospital cardiac arrest (OHCA) trend, provided advanced life support (ALS) measures, automated external defibrillator (AEDs) utilization and by-standers involvement in cardiopulmonary resuscitation (CPR) during OHCA incidents. Methods: This cross-sectional study encompassed data pertaining to all OHCA incidents attended to by the Emergency Medical Service of Canton Sarajevo, Bosnia and Herzegovina, covering the period from January 2018 to December 2022. Results: Among a total of 1131 OHCA events, 236 (20.8 %) patients achieved return of spontaneous circulation (ROSC); there were 175 (74.1%) males and 61 (25.9%) females. The OHCA incidence was 54/100.000 inhabitants per year. After a 30-day period post-ROSC, 146 (61.9%) patients fully recovered, while 90 (38.1%) did not survive during this timeframe. Younger age (p&lt;0.05), initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (p&lt;0.05) and faster emergency medical team (EMT) response time (p&lt;0.05) were significantly associated with obtaining ROSC. Only 38 (3.3%) OHCA events were assisted by bystanders, who were mostly medical professionals, 25 (65.7%), followed by close family members, 13 (34.3%). There was no report of AED usage. Conclusion: This follow-up study showed less ROSC achievement, similar bystanders&rsquo; involvement, similar factors associated with achieving ROSC (age, EMT response time) and a decline in OHCA events (especially in year 2021 and 2022) comparing to our previous study (2015-2019). There was an extremely low rate of bystander engagement and no AEDs usage. Governments and health organizations must swiftly improve public awareness, promote better practice (basic life support), and actively encourage bystander participation.

BACKGROUND Pharmacological treatment options for patients with dementia owing to Alzheimer's disease are limited to symptomatic therapy. Recently, the US Food and Drug Administration approved the monoclonal antibody lecanemab for the treatment of amyloid-positive patients with mild cognitive impairment (MCI) and early Alzheimer´s dementia. European approval is expected in 2024. Data on the applicability and eligibility for treatment with anti-amyloid monoclonal antibodies outside of a study population are lacking. AIMS This study examined eligibility criteria for lecanemab in a real-world memory clinic population between 1 January 2022 and 31 July 2023. METHOD We conducted a retrospective, single-centre study applying the clinical trial eligibility criteria for lecanemab to out-patients of a specialised psychiatric memory clinic. Eligibility for anti-amyloid treatment was assessed following the phase 3 inclusion and exclusion criteria and the published recommendations for lecanemab. RESULTS The study population consisted of 587 out-patients. Two-thirds were diagnosed with Alzheimer's disease (probable or possible Alzheimer's disease dementia in 43.6% of cases, n = 256) or MCI (23%, n = 135), and 33.4% (n = 196) were diagnosed with dementia or neurocognitive disorder owing to another aetiology. Applying all lecanemab eligibility criteria, 11 (4.3%) patients with dementia and two (1.5%) patients with MCI would have been eligible for treatment with this compound, whereas 13 dementia (5.1%) and 14 (10.4%) MCI patients met clinical inclusion criteria, but had no available amyloid status. CONCLUSIONS Even in a memory clinic with a good infrastructure and sufficient facilities for dementia diagnostics, most patients do not meet the eligibility criteria for treatment with lecanemab.

Vitamin D plays significant role in calcium metabolism and in bone and vascular calcifications. To investigate the association between vitamin D level, arterial hypertension, arterial stiffness and coronary calcifications detected by MSCT. Method: A 2 female case report comparative to each other investigated the correlation between vitamin D serum level, blood pressure, arterial stiffness and severity of the coronary calcification using MSCT diagnostic tool estimating the calcium score. The first case report showed that decreased level of vitamin D is correlated with increased blood pressure, increased arterial stiffness and with a severe coronary calcifications. The second case report showed normal blood pressure, normal vascular age and low calcium score in a no-defficient vitamin D female. Vitamin D has impact on blood pressure, arterial stiffness, coronary calcifications and coronary heart disease. The lower vitamin D, the higher arterial blood pressure, arterial stiffness and coronary calcium score.

Key Clinical Message The diagnosis of extensive pulmonary tuberculosis, especially in young people, should take into account the possibility of an associated systemic autoimmune disease. Infections remain an important cause of morbidity and mortalityin systemic lupus erythematosus. This case illustrates the importance of recognizing the association of systemic autoimmune diseases and infections and the need for a multidisciplinary approach.

Background and Objectives Myelin and iron play essential roles in remyelination processes of multiple sclerosis (MS) lesions. χ-separation, a novel biophysical model applied to multiecho T2*-data and T2-data, estimates the contribution of myelin and iron to the obtained susceptibility signal. We used this method to investigate myelin and iron levels in lesion and nonlesion brain areas in patients with MS and healthy individuals. Methods This prospective MS cohort study included patients with MS fulfilling the McDonald Criteria 2017 and healthy individuals, aged 18 years or older, with no other neurologic comorbidities. Participants underwent MRI at baseline and after 2 years, including multiecho GRE-(T2*) and FAST-(T2) sequences. Using χ-separation, we generated myelin-sensitive and iron-sensitive susceptibility maps. White matter lesions (WMLs), cortical lesions (CLs), surrounding normal-appearing white matter (NAWM), and normal-appearing gray matter were segmented on fluid-attenuated inversion recovery and magnetization-prepared 2 rapid gradient echo images, respectively. Cross-sectional group comparisons used Wilcoxon rank-sum tests, longitudinal analyses applied Wilcoxon signed-rank tests. Associations with clinical outcomes (disease phenotype, age, sex, disease duration, disability measured by Expanded Disability Status Scale [EDSS], neurofilament light chain levels, and T2-lesion number and volume) were assessed using linear regression models. Results Of 168 patients with MS (median [interquartile range (IQR)] age 47.0 [21.7] years; 101 women; 6,898 WMLs, 775 CLs) and 103 healthy individuals (age 33.0 [10.5] years, 57 women), 108 and 62 were followed for a median of 2 years, respectively (IQR 0.1; 5,030 WMLs, 485 CLs). At baseline, WMLs had lower myelin (median 0.025 [IQR 0.015] parts per million [ppm]) and iron (0.017 [0.015] ppm) than the corresponding NAWM (myelin 0.030 [0.012]; iron 0.019 [0.011] ppm; both p < 0.001). After 2 years, both myelin (0.027 [0.014] ppm) and iron had increased (0.018 [0.015] ppm; both p < 0.001). Younger age (p < 0.001, b = −5.111 × 10−5), lower disability (p = 0.04, b = −2.352 × 10−5), and relapsing-remitting phenotype (RRMS, 0.003 [0.01] vs primary progressive 0.002 [IQR 0.01], p < 0.001; vs secondary progressive 0.0004 [IQR 0.01], p < 0.001) at baseline were associated with remyelination. Increment of myelin correlated with clinical improvement measured by EDSS (p = 0.015, b = −6.686 × 10−4). Discussion χ-separation, a novel mathematical model applied to multiecho T2*-images and T2-images shows that young RRMS patients with low disability exhibit higher remyelination capacity, which correlated with clinical disability over a 2-year follow-up.