Abstract Hemorrhagic cystitis (HC) in children is most associated with infection or treatment-related toxicity, whereas other cases remain uncommon. We report a 5-year-old boy presenting with recurrent painless gross hematuria in whom a structured, stepwise evaluation excluded glomerular, infectious, structural, and systemic causes. Cystoscopy revealed diffuse mucosal inflammation with focal hemorrhagic changes involving the bladder neck and posterior wall, consistent with noninfectious HC. In the absence of an identifiable etiology and with persistent symptoms, management was directed toward restoring urothelial barrier integrity using intravesical hyaluronic acid (HA). The clinical response was rapid, with resolution of gross hematuria after the first instillation, followed by sustained remission and progressive endoscopic improvement. The treatment was well tolerated, and the patient remained disease-free at 12 months of follow-up. This case highlights the diagnostic complexity of unexplained hematuria in children and supports a potential role of urothelial barrier dysfunction in the pathogenesis of noninfectious HC.

Chronic kidney disease is increasingly recognised as a systemic disorder with important neurological consequences, including cognitive impairment. However, the field remains challenging because CKD-related cognitive decline involves diverse uremic toxins, overlapping vascular, inflammatory, metabolic, endothelial, and neurodegenerative pathways, inconsistent cognitive screening practices, and no unified treatment strategy. Within this context, the kidney–brain axis provides a useful framework for integrating renal dysfunction, toxin retention, systemic inflammation, blood–brain barrier disruption, and cognitive vulnerability. Of these mechanisms, uremic neurotoxicity offers a biologically credible connection between compromised renal clearance and cerebral dysfunction. Retained solutes such as indoxyl sulfate, p-cresyl sulfate, indole-3-acetic acid, trimethylamine-N-oxide, urea, guanidino compounds, lanthionine, quinolinic acid, and homocysteine may induce endothelial injury, oxidative stress, neuroinflammation, mitochondrial dysfunction, excitotoxicity, and glial activation. Although these pathways are supported by experimental and translational studies, direct causal evidence in humans remains limited, and most clinical data should currently be interpreted as associative rather than definitive proof of causality. These processes converge on neuronal and synaptic vulnerability and may elucidate the distinctive cognitive profile associated with chronic kidney disease, particularly deficits in attention, processing speed, and executive function. This review summarizes the most recent evidence on the epidemiology and clinical phenotype of cognitive impairment in chronic kidney disease. It also discusses the molecular and cellular mechanisms of uremic neurotoxicity and examines new biomarkers of the kidney–brain axis, including neurofilament light chain, glial fibrillary acidic protein, brain-derived neurotrophic factor, tight junction proteins, and uremic toxins. However, these biomarkers remain insufficiently validated for routine clinical use, as their interpretation is complicated by reduced renal clearance, systemic inflammation, comorbid vascular disease, methodological heterogeneity, and the lack of longitudinal studies linking biomarker changes to cognitive outcomes. Therapeutic strategies targeting uremic toxins remain compelling from a mechanistic standpoint, but they are not yet fully developed in clinical practice. Subsequent research ought to amalgamate toxin profiling, cognitive phenotyping, neuroimaging, endothelial and inflammatory biomarkers, alongside patient-centered outcomes. Integrating cognitive assessment into nephrology care may enhance risk stratification, collaborative decision-making, and personalised management for patients with chronic kidney disease.

The introductory section defines the concepts of graphomotor skills and hearing impairment.The aim of this study was to examine the characteristics of graphomotor skills in children with hearing impairments compared to hearing children. Additionally, one of the objectives was to investigate whether there are differences in graphomotor skills depending on the quality of hearing, as well as to identify the factors that influence these skills.For assessment purposes, the Diagnostic Set for Testing Speech, Language, Reading, and Writing Abilities in Children –Diagnostic Material for Identifying Specific Difficulties in Reading and Writing wasused, focusing on variables related to graphomotor skills. Descriptive statistics, optimal scaling regression analysis, and linear regression analysis were employed for statistical data processing.The study revealed that hearing participants achieved statistically significantly better results in graphomotor skills compared to participants with hearing impairments.The degree of hearing impairment affects the graphomotor skills of children with hearing impairment, while educational conditions and gender did not show any influence on these skills. Age also impacts the graphomotor skills of children with hearing impairment.These findings provide insight into the specific needs of children with hearing impairments and emphasize the importance of individualized education, taking into account the unique characteristics of each child with hearing impairment.Keywords: graphomotor skills, graphomotor development, children with hearing impairment

Digital narratives, particularly animated films, are increasingly recognized as powerful educational tools capable of fostering empathy and promoting inclusive values among school-age children. This study examined how viewing the animated film Jonathan from Seagull Mountaincontributes to the development of empathy and understanding of diversity among primary school students in Bosnia and Herzegovina. A mixed-methods design was employed, integrating quantitative and qualitative data collection and analysis.The sample comprised 214 students aged 9 to 15 years from four cities (Tuzla, Sarajevo, Zenica, and Mostar), while a purposive subsample of 32 students participated in four focus groups. Data were collected through a structured post-viewing questionnaire and semi-structured focus group discussions. Quantitative data were analyzed using descriptive statistics, while qualitative data from focus group transcripts were analyzed through thematic analysis. Results indicate that the film elicited positive emotional responses in the majority of participants, with 78.6% expressing a desire to help the protagonist and 78.0% reporting increased motivation to support peers who are different from them. Girls demonstrated markedly higher levels of affective empathy than boys, with the most pronounced difference recorded on the item relating to sadness over the protagonist's exclusion (86.5% vs. 53.6%). Thematic analysis identified five main themes: emotional experience of the narrative, development of empathy and acceptance of diversity, peer support and moral responsibility, symbolic elements, and student recommendations for more inclusive school practices. The findings confirm the potential of digital narratives as a pedagogical tool for developing empathy and inclusive attitudes among primary school students. Keywords:digital narratives, empathy, inclusion, animated film, primary school students

The aim of this study was to examine the impact of perceived stress levels on anxiety and depression among parents of children with disabilities. The study included a sample of 104 parents of children with different types of disabilities, of whom 85.6% were mothers and 14.4% were fathers. The Perceived Stress Scale (PSS-10) was used to assess the level of perceived stress, the Generalized Anxiety Disorder Scale (GAD-7) was used to assess anxiety, and the Patient Health Questionnaire (PHQ-9) was used to assess depression. Data were analyzed using descriptive statistics and linear regression analysis. The results indicated the presence of a moderate level of anxiety (M = 11.17; SD = 4.53), a moderately severe level of depression (M = 15.92; SD = 6.60), and a high level of perceived stress (M = 28.73; SD = 5.11) among parents of children with disabilities. Linear regression analysis showed that the level of perceived stress was a statistically significant predictor of anxiety (R² =0.25; p < 0.001) and depression (R² = 0.27; p < 0.001). The obtained findings indicate that higher levels of perceived stress contribute to higher levels of anxiety and depression among parents of children with disabilities. The study results highlight the need for the development of systematic psychological and social support for parents of children with disabilities in order to preserve their mental health. Keywords:perceived stress, anxiety, depression, parents of children with disabilities, mental health, psychological burden

BACKGROUND Fractures in older adults arise from complex interactions between bone fragility, falls, and comorbid conditions. This study aimed to map the comorbidity environment of osteoporosis (M80/M81) by sex and age, and assess whether osteoporosis is systematically coded at the time of fracture-related hospitalization across fracture types. METHODS We conducted a nationwide retrospective analysis of Austrian inpatient data collected for insurance claims between 2003 and 2014, including 1,705,684 hospitalized patients aged 50-79 years. Comorbidity network analysis was used to characterize sex- and age-specific diagnoses co-occurring with osteoporosis (ICD-10: osteoporosis with pathological fracture M80 and osteoporosis without pathological fracture M81). In paralell, fracture-centered networks were constructed for major fracture types (S22, S32, S42, S52, S62, S72) to assess whether osteoporosis was systematically coded during fracture related hospitalizations. Sex-specific odds ratios (ORs) were calculated to compare comorbidity associations between males and females across three age groups (50-59, 60-69, 70-79 years). RESULTS Across all age groups, females exhibited substantially broader M81-associated comorbidity networks than males, with the number of linked diagnoses increasing from 142 to 245 to 330 in females and from 76 to 137 to 164 in males between ages 50-59, 60-69, and 70-79 years, respectively. Fracture-centered analyses showed that across age groups, fractures were embedded within multimorbidity networks rather than forming isolated diagnostic links with osteoporosis. Hip fractures (S72) showed the strongest co-occurrence with osteoporosis diagnoses, particularly in females aged ≥60 years, whereas upper limb fractures - forearm (S52), wrist and hand (S62), and humerus (S42) - showed no osteoporosis diagnoses among significant co-diagnoses in any age group despite these fractures being considered early fragility fractures. In patients aged 50-69 years, male fracture networks showed stronger co-occurrence with trauma-related and alcohol-related diagnoses, while in older age groups networks in both sexes increasingly included neurodegenerative, cardiovascular, respiratory, and renal diseases. In sex-stratified analyses, the co-occurrence between osteoporosis without pathological fracture (M81) and osteoporosis with pathological fracture (M80) was consistently stronger in males than in females across all ages (e.g. OR 63.74 vs 18.53 at 50-59 years). CONCLUSIONS Osteoporosis is not systematically coded across all fracture types in routine hospital data. Upper limb and thoracic fractures were rarely recorded alongside osteoporosis diagnoses despite being recognized as potential fragility fractures. These patterns suggest under-recognition of osteoporosis at the time of fracture, particularly in younger patients and in males.

The aim of the study was to examine the level of knowledge and awareness of healthcare professionals regarding feeding, sucking, and swallowing disorders, as well as their understanding of the role of speech and language therapists in the diagnosis and treatment of these disorders. The study was conducted on a sample of 51 healthcare professionals from public and private healthcare institutions in the Una-Sana Canton, using a questionnaire specifically designed for the purposes of this research.According to the results, 56.9% of respondents had received formal education on dysphagia, while only 27.5% had undergone training in the field of pediatric feeding disorders. Clinical experience with dysphagia was reported by 64.7% of respondents, whereas experiencewith pediatric feeding disorders was reported by 25.5%. Although 68.6% of respondents reported being familiar with the distinction between the terms “dysphagia” and “feeding disorders,” only 29.4% demonstrated a professionally grounded understanding of these concepts.Participation in diagnostic procedures related to pediatric feeding disorders was reported by 9.8% of respondents, while 7.8% reported participation in therapeutic interventions. In cases of dysphagia, 35.3% of respondents reported involvement in diagnostic procedures, whereas 17.6% participated in therapeutic treatment. Only 7.8% of respondents identified the speech and language therapist as a key member of the multidisciplinary team.Respondents also assessed the strengthening of knowledge on pediatric feeding disorders and dysphagia as being of high professional importance. The results indicate significant gaps in knowledge, education, and clinical involvement among healthcare professionals, particularly regarding the recognition of the roleof speech and language therapists, while respondents simultaneously express a high level of readiness for further professional development. These findings highlight the need for continuous and systematic education, as well as for strengthening interprofessional collaboration.Keywords: dysphagia; pediatric feeding disorders; healthcare professionals’ knowledge and competencies; speech-language pathology; multidisciplinary team

Vocal fold nodules (VFNs) are the main cause of paediatricdysphonia. Voice therapy is regarded as the preferred treatment approach for VFNs in children. The aim of this study was to evaluate voice characteristics before and after voice therapy using acoustic analysis. Thirty female patients with VFNs were enrolled in this study. Each patient underwent voice therapy conducted by an experienced voice therapist twice a week. Acoustic voice assessments were performed before and after the therapeutic intervention. Acoustic analyses were performed using computerized acoustic voice analysis. Post-therapy findings demonstrated a consistent and statistically significant improvement across multiple acoustic parameters. Significant reductions were observed in jitter and shimmer measures, as well as in noise-related acoustic parameters such as the noise-to-harmonics ratio, suggesting improved stability and efficiency of vocal fold vibration. Fundamental frequency showed a slight decrease following therapy. Overall, these findings indicate a more stable, less perturbed, and acoustically improved voice signal after intervention. The findings of this study suggest the effectiveness of voice therapy in improving acoustic voice parameters in children with VFNs. The observed improvements highlight the importance of early and structured behavioral intervention in pediatric dysphonia and reinforce the role of acoustic analysis as a valuable tool for objective assessment of therapeutic outcomes. Keywords: vocal fold nodules, dysphonia, voice therapy, acoustic analysis.

Abstract Heterobranch sea slugs represent one of the most diverse groups of marine gastropods in the Mediterranean Sea; however, their diversity and distribution along the short coastline of Bosnia and Herzegovina remain insufficiently documented. In this study, we report the first confirmed record of the sacoglossan nudibranch Elysia gordanae T. E. Thompson & Jaklin, 1988 from the marine waters of Bosnia and Herzegovina. A single specimen was observed and collected in the intertidal zone of Neum Bay during field surveys conducted in August 2023. Morphological characteristics correspond well with published descriptions of the species. This finding represents the easternmost confirmed record of E. gordanae in the Adriatic Sea to date and contributes to the growing knowledge of heterobranch diversity in Bosnia and Herzegovina, highlighting the need for continued systematic surveys of its poorly explored marine habitats.