Objective: This retrospective (matched paired) clinical trial aimed to compare the efficacy of dexamethasone vs. methylprednisolone at equipotent (high) doses in patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS). Methods: A total of 347 patients with moderate and severe COVID-19-associated ARDS were administered either a high (equipotent) dose of dexamethasone (32 mg) or methylprednisolone (180 mg) for a duration of up to 10 days. All participants received the standard of care for critically ill COVID-19 patients. Results: The primary outcomes included length of stay in the ICU, ICU mortality, and discharge from the hospital. Based on the obtained results, a tendency towards more favorable clinical outcomes concerning the length of stay in the ICU (in the group of patients treated with non-invasive mechanical ventilation (NIV), p<0.05), ICU mortality, and discharge from the hospital (in the group of patients who were intubated, p<0.05) in patients receiving the high dose of dexamethasone compared to those receiving methylprednisolone was observed. Conclusion: It appears that severe cases of COVID-19, especially intubated ones, treated with high doses of dexamethasone have a more favorable clinical outcome than the use of equipotent doses of methylprednisolone. However, larger multicenter studies are needed to validate our observations.

Abstract Introduction: Melkersson Rosenthal syndrome (MRS) is a disease of multifactorial origin typically presented with a triad of symptoms including peripheral facial nerve paralysis, plicated tongue and orofacial edema. Diagnosing MRS requires the exclusion of other granulomatous diseases and the correlation of clinical with histopathological finding. Case presentation: We present the case of a 56-year-old female with a four-month history of lower lip and right mandible angle swelling together with a plicated tongue that appeared during COVID-19 infection. The patient was successfully treated with intralesional Triamcinolone Acetonide at a dose of 40 mg. Conclusion: The presented case is specific by its late onset since the patient experienced their first symptoms in fifties, which differs from the majority of cases where the diagnosis is usually established in young adults. Infectious factors are established as possible etiologic factors of MRS, but few cases are described to be triggered or worsened by COVID-19 infection.

A Computed Tomography Urography (CTU) scan is a medical imaging test that examines the urinary tract, including the bladder, kidneys, and ureters. It helps diagnose various urinary tract diseases with precision. However, patients undergoing CTU imaging receive a relatively high dose of radiation, which can be a concern. In our research paper, we analyzed the Computed Tomography Dose Index (CTDIvol) and Dose-Length Product (DLP) for 203 adult patients who underwent CTU at one of the most important regional centers in Bosnia and Herzegovina that sees a large number of patients. Our study included the distribution of age and sex, the number of phases within one examination, and different clinical indications. We compared our findings with the results available in the scientific literature, particularly the recently published results from 20 European countries. Furthermore, we established the local diagnostic reference levels (LDRLs) that can help set the national diagnostic reference levels (NDRLs). We believe our research is a significant step towards optimizing the protocols used in different hospitals in our country.

Polyphenols are natural compounds with enhanced antioxidant properties. They are present in relatively high concentrations in fruit/vegetable by-products. Therefore, there is a need for the development of efficient and cost-effective methods for the separation and purification of these valuable compounds. Traditional extraction with organic solvents needs to be switched to novel methods that are more efficient, with reduced extraction times and low consumption of organic solvents. Aiming at developing sustainable processes for the separation and purification of phenolic compounds, we used three model compounds, namely resveratrol, quercetin, and gallic acid, to investigate ionic liquid-based aqueous biphasic systems (IL-ABSs) formed by cholinium-based IL in combination with polypropylene glycol with a molecular mass of 400 g/mol (PPG400). The ABS composition in the two-phase region was selected according to a previously determined phase diagram. Extraction studies indicated the preferential partition of resveratrol and quercetin toward the hydrophobic PPG-rich phase that is mainly dominated by its hydrophobic nature and the strong salting-out effect of ILs. On the other hand, due to its considerably hydrophilic nature, gallic acid preferentially migrates toward the IL phase. The achieved results from grape stem extract demonstrated high extraction efficiencies of cholinium dihydrogen phosphate (~99% for resveratrol for the PPG phase and 78% for gallic acid for the IL phase), with considerable selectivity, demonstrating promising outcomes for potential applications.

Motor neuron diseases (MNDs) are a group of relatively rare, progressive neurodegenerative conditions (with amyotrophic lateral sclerosis/ALS being the most common) characterized by degeneration of upper and lower motor neurons leading to motor and extra motor symptoms. The etiology of MND is believed to involve complex interactions of environmental, lifestyle, and genetic factors, but so far only a few convincing risk factors have been established. Several putative risk factors associated with sporadic cases have been suggested, including repetitive blows to the head and traumatic brain injury. ALS is considered a sporadic disorder in 90% of cases. The incidence of ALS in the United States is 1.5 to 2.2 per 100.000, but varies significantly by age, sex, and race. The incidence of ALS generally increases with age and peaks during the seventh decade of life. There is not a large number of relevant studies for reliable conclusions about the connection between sports and BMN. However, there is increasing interest in the role of contact sports (eg, American football and rugby) following the diagnosis of BMN in several high-profile professional athletes. Several case-control studies have found an increased risk of MND among people who engage in strenuous physical activity, but other studies of this type did not find this risk (association) or the association was negative. Several other studies have shown an increased risk of BMN with traumatic brain injury, while others have found no association. The risk of MND varies depending on the type of sport played. For many individual sports, no increased risk of BMN was observed, including cricket, basketball, tennis, swimming, hockey, volleyball, badminton, field hockey, sailing, rowing, diving and skiing. However, several meta-analyses have shown a 1.3 to 1.7 times higher risk of MND in athletes who suffer a head injury, compared to the general population. Experience shows that exercise can be physically and psychologically important for people with ALS. Although the results so far do not provide clear conclusions regarding physical therapy or/and exrecise regimens to maintain function and quality of life in people with ALS, we can say, for sure, that moderate exercise is not harmful. Regarding the type of exercise, moderate intensity and not very high frequency (two sessions per week), combining strength and aerobic resistance, may be the best option to see improvements in ALS patients and prevent fatigue that further impairs their quality of life.Key words: amyotrophic lateral sclerosis – sports – physical therapy

Abstract Parasitic diseases of wild animals represent an important area of research. In addition to the significant impact on wildlife health and fitness, many parasitic diseases have zoonotic implications. Due to limited scientific information, this research aimed to investigate parasitic diseases in wildlife in Bosnia and Herzegovina (B&H), focusing on the Federation of Bosnia and Herzegovina (FB&H), emphasizing zoonotic species. In the period from April 2020 to November 2022, we conducted research on 9 wildlife species. We analyzed fecal samples to detect and identify diagnostic stages (eggs, larvae, cysts, and oocysts) of various animal endoparasites using coprological methods, such as sedimentation, flotation, and the Baermann technique. The MERIFLUOR® Cryptosporidium/Giardia test was also used for the detection of Cryptosporidium oocysts and Giardia cysts. In the case of red foxes, intestinal samples were examined using the intestinal scraping technique to detect adult helminths. All collected muscle samples were subjected to the artificial digestion method for Trichinella detection. From 1,278 samples, 70.9% were positive. Parasitic infections were confirmed in 15.9% (11/69) of bears; 83.7% (262/313) of red foxes; 67.6% (44/65) of wolves; 25% (1/4) of wildcats; 20% (1/5) of badger; 43.7% (7/16) of martens; 39.7% (76/191) of wild boars; 84.5% (350/414) of deer, and 77.1% (155/201) of hares. The finding of zoonotic parasites (Toxocara canis, Uncinaria spp., Trichinella spp., Echinococcus spp. etc.) is particularly important due to their potential detrimental effects on human health, which highlights the need for further investigations.

Objective Older adults constitute a heterogeneous group, and the focus of the individual physical exercise is often subject to the reasoning and experience of health professionals or exercise physiologists who prescribe them. Thus, this is the first effort to explicitly conceptualise the planning of individualised physical exercise training (IPET) for older adults in an outpatient setting and investigate individual exercise preferences. Design The concept of IPET was developed by researchers, exercise physiologists and health professionals from a real-life outpatient setting using an iterative approach. Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites form the basis of physical exercise recommendations. A cross-sectional study was conducted to assess the basis of implementing IPET. Setting Outpatient setting. Participants We included 115 older adults (70 females) from an outpatient setting with a median age of 74 years. Outcome measures Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites were collected and informed the concept of IPET that structures exercise programmes based on the individual citizen’s needs and physical exercise preferences. Exceeding a health indicator cut-point results in exercise content mitigating the risk associated with the health indicator. Results We included 115 older adults (70 females) from an outpatient setting median age of 74 years. Approximately two-thirds of participants exceeded at least one health indicator cut-point for aerobic training. One-third of the participants exceeded the cut-point for upper extremity strength, and almost all participants >99% exceeded the cut-point for lower extremity strength. Approximately two-thirds of the participants exceeded the cut-point for functional/balance training. The most prevalent site of musculoskeletal pain was the lower extremities. Eight of 20 training combinations were used, clustering the 115 participants primarily in three main training combinations. Discussion This study shows that older adults vary in physical functioning, indicating that exercise preferences and rehabilitation needs are individual. Trial registration number NCT04862481.

In recent decades, conventional medicine has begun to include natural remedies and spiritual therapy in the treatment of people with mental disorders, and in recent years, physicians and healthcare professionals more often refer to alternative and complementary methods in the treatment of mental disorders. Alternative medicine includes “other treatments” and a more suitable term would be complementary medicine which supplements the definition of conventional medicine accepted by the World Health Organization. After the rise of pharmaceutical industry in the second half of the 20th century and significant advancement in the treatment of mental disorders, comes a period of disappointment and acceptance of the fact that synthetic drugs are not omnipotent and may have serious and unpleasant side-effects. Due to this fact, there is a growing interest in the treatment of mental disorders with the use of complementary methods. It is important to note that these methods are not a substitute for standard treatment procedures and their appropriate application does not diminish the importance of classical treatment of psychiatric disorders. Numerous patients refuse classical therapy and seek the help of complementary medicine methods. It is therefore important for physicians and healthcare professionals to have knowledge of complementary medicine which is science based and advises on treatment methods provided they are scientifically justified. Key words: complementary medicine, psychiatry

Objective Older adults constitute a heterogeneous group, and the focus of the individual physical exercise is often subject to the reasoning and experience of health professionals or exercise physiologists who prescribe them. Thus, this is the first effort to explicitly conceptualise the planning of individualised physical exercise training (IPET) for older adults in an outpatient setting and investigate individual exercise preferences. Design The concept of IPET was developed by researchers, exercise physiologists and health professionals from a real-life outpatient setting using an iterative approach. Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites form the basis of physical exercise recommendations. A cross-sectional study was conducted to assess the basis of implementing IPET. Setting Outpatient setting. Participants We included 115 older adults (70 females) from an outpatient setting with a median age of 74 years. Outcome measures Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites were collected and informed the concept of IPET that structures exercise programmes based on the individual citizen’s needs and physical exercise preferences. Exceeding a health indicator cut-point results in exercise content mitigating the risk associated with the health indicator. Results We included 115 older adults (70 females) from an outpatient setting median age of 74 years. Approximately two-thirds of participants exceeded at least one health indicator cut-point for aerobic training. One-third of the participants exceeded the cut-point for upper extremity strength, and almost all participants >99% exceeded the cut-point for lower extremity strength. Approximately two-thirds of the participants exceeded the cut-point for functional/balance training. The most prevalent site of musculoskeletal pain was the lower extremities. Eight of 20 training combinations were used, clustering the 115 participants primarily in three main training combinations. Discussion This study shows that older adults vary in physical functioning, indicating that exercise preferences and rehabilitation needs are individual. Trial registration number NCT04862481.

Objective Long-standing diabetes mellitus is often associated with cardiovascular complications. We aimed to evaluate the presence, extent and composition of subclinical atherosclerotic plaques in coronary arteries by Computed Tomography in patients with newly diagnosed type 2 diabetes mellitus (NDT2DM), and to identify the predictors. Methods In this study 101 consecutive patients with NDT2DM were included. Patients were categorized into five groups based on their Coronary Artery Calcium Score (CACS) ranging from 0, 0-10, 11-100, 101-400 to >400. All parameters were compared across these groups. Results The average patient age was 54.4 ± 11.6 years and 48 (47.5%) were females. Eight (7.9%) patients had CACS 0, 6.9% CACS 1-10, 42.6% CACS 11-100, 22.8% CACS 101-400 and 19.8% had CACS >400. Multiple regression analysis for the general data identified weight (p = .04) and systolic blood pressure (p = .033) as independent predictors for CACS. Conclusions Asymptomatic patients with NDT2DM in more than 90% of cases may present with calcified atherosclerotic plaques and this may be predicted by: patient weight and the level of systolic arterial pressure. Our study emphasizes the need for comprehensive care and early prevention of cardiovascular complications in individuals with NDT2DM.

Elevated concentrations of heavy metals result in soil degradation, a reduction in plant yields, and a lower quality of agricultural products, which directly endangers people, animals, and the ecosystem. The potential of three clones of Salix alba (347, NS 73/6, and B-44) and one genotype of S. viminalis for the phytoextraction of heavy metals was investigated, with the aim of identifying the most physiologically suitable willow genotypes for use in soil phytoremediation. The experiment was placed on the contaminated soil substrate collected in Kolubara Mining Basin (Serbia), enriched by high loads of heavy metal salts, and a control medium. Significant differences in the concentrations of heavy metals were recorded between the contaminated and control plant material, especially when it comes to nickel (Ni), copper (Cu), cadmium (Cd), and lead (Pb), confirming that S. alba and S. viminalis are hyperaccumulator species of heavy metals. Clone 347 shows the greatest uptake of Cd and chromium (Cr), and clone B-44 takes up these metals only to a lesser extent, while clone NS 73/6 shows a less pronounced uptake of Cr. The roots have the greatest ability to accumulate Ni and Pb, Cu is absorbed by all plant organs, while Cd is absorbed by the leaves. The organ that showed the greatest ability to accumulate heavy metals was the root, which means that willows have a limited power to translocate heavy metals to above-ground organs. The studied genotypes of S. alba have a higher potential for the phytostabilization of Cu and Cd, as well as the phytoextraction of Cd, compared with S. viminalis. The results confirm the assumption of differences between different willow genotypes in terms of the ability to phytoextract certain heavy metals from soil, which is important information when selecting genotypes for soil phytoremediation.

a significant increase in errors due to background noise in operating

Abstract Hemodiafiltration is a method of treatment used to replace kidney function, which effectively removes uremic toxins of middle molecular weight from the blood of patients with the end-stage of chronic kidney disease. The aim of this study was to examine the effect of postdilution online hemodiafiltration on the degree of β2- microglobulin removal. Thirty patients treated with postdilution online hemodiafiltration were examined. The main parameter for assessing the removal efficiency of uremic toxins of middle molecular weight was the concentration of β2-microglobulin in the serum before and after a single session of postdilution online hemodiafiltration. The following tests were used for statistical analysis: Shapiro-Wilk test, Student’s T test for bound samples and Wilcoxon test. The average total convective volume is 21.38 ± 2.97 liters per session. The reduction index of β2-microglobulin during a single session of postdilution online hemodiafiltration is 70.86 ± 6.87%. The average loss of albumin during a single postdilution online hemodiafiltration is 2.50 ± 0.92 g/4h, and the albumin reduction index is 6.20 ± 2.12%. Postdilution online hemodiafiltration effectively removes β2-microglobulin from the blood of patients with end-stage chronic kidney disease. The reduction index of β2-microglobulin is ˜ 71.00% and the loss of albumin is less than 4.0 g/4h. This dialysis modality prevents the development of dialysis-related amyloidosis and atherosclerotic cardiovascular diseases in the population of patients treated with regular hemodiafiltration.

AIMS Interstitial high-dose-rate brachytherapy (HDR-BT) is an effective therapy modality for patients with localized prostate carcinoma. The objectives of the study were to optimise the therapy regime variables using two models: response surface methodology (RSM) and artificial neural network (ANN). MATERIALS AND METHODS Thirty-one studies with 5651 patients were included (2078 patients presented as low-risk, 3077 patients with intermediate-risk, and 496 patients with high-risk). A comparison of these therapy schedules was carried out using an effective biologically effective dose (BEDef) that was calculated assuming the number of treatment days and dose (D) per day. The modelling and optimization of therapy parameters (BEDef and risk level) in order to obtain the maximum biochemical free survival (BFS) were carried out by the RSM and ANN models. RESULTS An optimal treatment schedule (BFS = 97%) for patients presented with low-risk biochemical recurrence would be D = 26 Gy applied in one application, 2 fractions at least 6 h apart, within an overall treatment time of 1 day (BEDef = 251 Gy) by the RSM and ANN model. For patients presented with intermediate- or high-risk an optimal treatment regime (BFS = 94% and 90%, respectively) would be D = 38 Gy applied in one application, 4 fractions at least 6 h apart, with an overall treatment time of 2 days (BEDef = 279 Gy) by the RSM and ANN models. CONCLUSIONS The RSM and ANN models determine almost the same optimal values for the set of predicted therapy parameters that make a feasible selection of an optimal treatment regime.