Abstract In the dynamic field of power systems, integrating distributed generation (DG) sources like solar photovoltaic (PV) plants is crucial for enhancing reliability and fostering sustainability. However, this integration poses voltage profile management challenges in electrical grids. This study investigates voltage profile optimization in Bosnia and Herzegovina’s Gračanica network, focusing on a medium voltage feeder with 68 buses. Using DIgSILENT PowerFactory software, six scenarios with different configurations of solar plants are analyzed for their impact on voltage profiles and power losses. Results show that while DG integration offers benefits, incorrect sizing or placement can increase power losses. Optimal DG benefits are linked to specific sizes and locations. This research emphasizes the need for balancing PV generation with load demands and provides insights for optimal PV plant size and output to minimize negative impacts. These findings aid energy planners and policymakers in implementing distributed solar PV in medium voltage networks.

Open access implies the idea of scientific information dissemination over the Internet that is free to the end user. The higher education and university libraries’ mission is to connect people and information, and the goals of open access help librarians respond to users' information queries more quickly. This paper presents the basic concepts of open access with an emphasis on creating an open access journal through ten steps. The open access portal at the University of Sarajevo is also presented within the paper, as well.

BACKGROUND To assess 28-day survival in two pilot groups of septic shock patients with euthyroid sick syndrome (ESS) supplemented with triiodothyronine (T3). METHODS A total of 95 septic shock patients with ESS were divided according to values of the thyroid hormones into low T3 and low T3T4 groups. Among 48 patients with low T3, 24 (50%) were randomized to T3 for 4 days and 24 (50%) to placebo. Among 47 patients with low T3T4, 24 (51%) were randomized to T3 for 4 days and 23 (49%) to placebo. The analysis included 28-day survival as the primary outcome and laboratory with hemodynamics as the secondary outcome. Laboratory data were analyzed on the day of admission (t0), on the first (t1), third (T2) and seventh day (t3) with hemodynamics analyzed for the first four days. RESULTS In the low T3 population, 18 (75%) patients receiving T3 died at day 28 compared with 8 (33.3%) patients receiving placebo (p = 0.004). In the low T3T4 population, 6 (25%) patients receiving T3 died in ICU compared with 12 (52.1%) patients receiving placebo (p = 0.039). Oral T3 treatment increased mean arterial pressure values at day 1, day 3 and day 7 in the low T3T4 population, (p = 0.015, =0.005 and =0.042 respectively), and had no significant effect on these values in the low T3 population. CONCLUSION T3 supplementation was associated with a low 28-day mortality rate in patients with low T3T4 but with increased mortality in patients with low T3 ESS. These results suggest caution before initiating thyroid supplementation in septic patients. REGISTRATION ClinTrials.gov (NCT05270798).

Introduction Much has been written and spoken about telemedicine since about two decades including an article in this journal at the start of the pandemic. It took a global catastrophe to enforce its usage across the world in various medical specialties. Telemedicine however remains unstructured, unregulated and lacks uniformity. Discussion This article highlights the practical learnings and opinions of the authors who provided over two thousand video consults and asynchronous telemedicine services through the entire pandemic. It includes lessons learnt from emerging economies where pediatric rheumatologists are scarce. Pediatric rheumatology, which relies heavily on history, musculoskeletal and skin examination is aptly suited to exploit telemedicine in its synchronous and asynchronous forms. Pediatric tele rheumatology could temporarily address the shortage and uneven distribution of specialists in vast parts of the globe, besides serving as a method of triage and shared care with the primary physician. Reduction of direct and indirect costs and family/primary physician education are additional benefits. There also exist challenges for all stakeholders and it is important to address the latter. Conclusion The learnings of the pandemic suggest a vital role for telemedicine in the practice of pediatric rheumatology. This is a fertile area for research and consensus building by international and national pediatric societies and issue position statements like some adult bodies already have. The authors speculate a hybrid system of care in the not-so-distant future.

Objectives This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe. Methods A questionnaire was sent to ACHD cardiologists from 34 European countries. Results Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors ‘on the job’. The median number of ACHD centres per country was 4 (range 0–28), median number of ACHD surgical centres was 3 (0–26) and the median number of ACHD training centres was 2 (range 0–28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001). Conclusion Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to ‘train people on the job’. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care.

Abstract Background  Many recent studies show that exoscopes are safe and effective alternatives to operating microscopes (OM). Developments of robotics and automation are present in neurosurgery with the appearance of a newer device such as RoboticScope (RS) exoscope with a digital three-dimensional (3D) image and a head-mounted display. The body of the RS is connected to a six-axis robotic arm that contains two video cameras, and serves as stereovision. This robotic arm allows accurate 3D camera motions over the field of view, giving the user a great degree of freedom in viewpoint selection. The surgeons may specify the direction and speed of the robotic arm using simple head movements when the foot pedal is pressed. Since its development in 2020, the RS has occasionally been used in neurosurgery for a multitude of procedures. Methods  This study showcases vessel microanastomosis training on chicken legs using the RS. The aim of this study is to demonstrate the feasibility of the RS without a comparative analysis of the standard OM. The study was conducted in 2023 during a month-long trial period of the device at the Department of Neurosurgery of the Clinical Center of the University of Sarajevo. All procedures including RS-assisted anastomosis were performed by a neurosurgeon in anastomosis training (A.A.) supervised by a senior vascular neurosurgeon (E.B.). For the purpose of the study, we evaluated occlusion time in minutes, bypass patency with iodine, and overall satisfaction of the trainee in terms of light intensity, precision of automatic focus, mobility of the device, ergonomics, and convenience of the helmet. Results  Ten RS-assisted microanastomoses were performed by interrupted suturing technique with 10.0 nylon thread. Bypass training included seven “end-to-side,” two “end-to-end,” and one “side-to-side” microanastomoses. The smallest vessel diameter was 1 mm. Occlusion time improved by training from 50 to 24 minutes, with contrast patency of the anastomoses in all cases without notable leakage of the contrast, except one case. Complete satisfaction of the trainee was achieved in 7 out of 10 cases. During this period, we also performed different RS-assisted surgeries including a single indirect bypass, convexity brain tumor resection, and microdiscectomies. Conclusion  RS provides a new concept for microanastomosis training as an alternative or adjunct to the standard microscope. We found a full-time hands-on microsuturing without the need for manual readjustment of the device as an advantage as well as instant depth at automatic zooming and precise transposition of the focus via head movements. However, it takes time to adapt and get used to the digital image. With the evolution of the device helmet's shortcomings, the RS could represent a cutting-edge method in vessel microanastomosis in the future. Nevertheless, this article represents one of the first written reports on microanastomosis training on an animal model with the above-mentioned device.

Background. The management of breast cancer treatments within the limitations of family, social, and professional life is emotionally burdening and negatively affects physical, psychological, and social well-being, reducing the overall quality of life of patients and their families. Methods: This cross-sectional descriptive–analytical study was conducted from March to August 2023 at the “Dr. Radivoj Simonović” General Hospital in Sombor. A total of 236 breast cancer patients participated in this study. The research was conducted using the following instruments: a questionnaire on sociodemographic and clinical characteristics of patients, the Berlin Social-Support Scales—for assessing social support—and the Connor–Davidson Resilience Scale—for assessing resilience. This study aimed to determine the predictors and levels of social support and resilience of breast cancer patients. We also wanted to examine whether resilience is a mediator between patients’ sociodemographic and clinical characteristics and levels of social support. Results: The total average value of social support was 3.51 ± 0.63, while on the resilience scale, the respondents achieved a total average score of 52.2 ± 9.63. Perceived and actually received social support of breast cancer patients were positively correlated with resilience [p < 0.01], while no statistically significant correlations were found for the need for support and satisfaction. The sets of predictors can significantly predict their effects on all types of perceived social support (emotional social support: 9%; perceived instrumental social support: 9%) and all types of received social support (actually received emotional social support: 8%; actually received instrumental social support: 7%; actually received informational social support: 8%). There is a potential mediating role of resilience in relation to sociodemographic factors, clinical characteristics, and the need for support. Conclusion: This study confirms that a strong connection exists between social support and resilience. However, the analysis did not confirm the mediating role of resilience between the sociodemographic and clinical characteristics on the one hand and social support on the other.

Pravilnom pripremom hrane moguće je spriječiti većinu hranom prenosivih bolesti. Značajni napori uloženi u usaglašavanje legislative na širim geografskim područjima, rezultovali su formiranjem općeprihvaćenog stava da je većina kupljenih namirnica sigurna za konzumiranje. Međutim, neophodno je da potrošači nastave dobre prakse rukovanja, pripremanja i čuvanja namirnica u domaćinstvima. Ovo istraživanje je provedeno kao presječna, deskriptivno-analitička i eksperimentalna studija u periodu novembar 2020. – juli 2021. godine. Mikrobiološka analiza briseva je provedena u akreditovanoj laboratoriji Odjela za mikrobiološku analizu namirnica, voda i predmeta opšte upotrebe pri Zavodu za javno zdravstvo Federacije Bosne i Hercegovine. U domaćinstvima je uzorkovano po 7 briseva radnih površina i pribora u kuhinjama (n = 2681) u skladu sa smjernicama standardne metode BAS EN ISO 18593:2019 – Horizontalne metode za uzimanje uzoraka sa površine. U više od polovine domaćinstava (61,5%) izolovane su ciljane bakterije u vrijednostima iznad referentnih. Najveća odstupanja u bakteriološkoj ispravnosti utvrđena su na radnim površinama u kuhinjama (45,8%), daskama za rezanje (34,1%) i slavinama (34,1%). Staphylococcus aureus je izolovan u 153, Enterobacteriacea u 151, a aerobne bakterije u 286 domaćinstava. Prema kategorizaciji ukupnog rizika, 17% domaćinstava na području Kantona Sarajevo spada u kategoriju visokog rizika od hranom prenosivih bolesti u svojim domaćinstvima. Obzirom da javnost nije upoznata sa rizikom u kojem se nalazi, smatramo da je što hitnije potrebno poduzeti korake u podizanju kolektivne svijesti o javno-zdravstvenom značaju sigurnosti hrane u domaćinstvima.

Introduction: Hypothyroidism is a common disorder of the endocrine system caused by insufficient biologically active hormones at the tissue level or the inability of the tissue to utilize thyroid hormones. Iron plays a crucial role in the synthesis and metabolism of thyroid hormones, and it is stored in the body as ferritin. We aimed to evaluate the correlation between serum ferritin (SF) levels and thyroid hormone panel levels in both hypothyroid and euthyroid subjects. Methods: In 2022, a matched case–control study was conducted. The study involved participants with hypothyroidism and a control group (n = 53). The levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and SF were measured using the chemiluminescence immunoassay on a Mindray Cl 900-i analyzer (Shenzhen Mindray Bio-Medical Electronics Co., China). Results: The hypothyroid group had TSH levels that were significantly higher (10.76 [8.54-18.76] vs. 1.76 [1.26-2.58]; p < 0.001) and SF concentrations that were significantly lower (39.08 [21.15-45.70] vs. 54.09 [41.41-71.82]; p < 0.001) compared to the control group. In both male and female subjects of the hypothyroid group, a strong negative correlation was found between SF concentration and TSH levels ([Rho = −0.855,p < 0.01]; [Rho = −0.747; p < 0.01]). In female subjects of the hypothyroid group, a weak positive correlation was found between SF concentration and fT3 (Rho = 0.488; p < 0.05). In the euthyroid group, a correlation of the same strength and direction was found for fT4 (Rho = 0.366; p < 0.05). Conclusion: Research results indicate a correlation between lower SF concentrations and hypothyroidism, which is of particular importance for understanding the etiopathogenesis, diagnosis, monitoring, and treatment modalities of patients with hypothyroidism.

Kultura sigurnosti je set vrijednosti, znanja, vještina, stavova i prakse na individualnom i institucionalnom nivou organizacije radioterapijskog procesa koji uspostavlja način rada u kojem sigurnost i zaštita zdravlja predstavljaju prioritet prilikom obavljanja radnih zadataka. Razvoj kulture sigurnosti na individualnom i institucionalnom nivou postalo je jedno od ključnih sigurnosnih pitanja u savremenoj radioterapiji. Cilj ovog istraživanja je procijeniti mogućnost upotrebe elektronskog sistema za prijavljivanje incidenata u razvoju kulture sigurnosti kod zdravstvenih profesionalaca u radioterapiji i mogućnost izgradnje sistemske primjene seta vrijednosti koji omogućava obavljanje svih radnih zadataka u radioterapiji uz davanje maksimalnog priorieta sigurnosti. Kao instrument istraživanja korišten je elektronski sistem za prijavljivanje incidentata u formi strukturiranog kompjuterskog intervjua prema ROSEIS metodologiji. Na osnovu informacija prikupljenih pomoću sistema napravljena je procjena razvijenosti različitih segmenata kulture sigurnosti, predložene mjere na njenom razvoju i poboljšanju, te data pocjena njihove efikasnosti u unaprijeđenju sigurnosti u radioteapiji. Razvijena kultura sigurnosti u radioterapijskom radnom okruženju može značajno unaprijediti kvalitet radioterapijskog tretmana, reducirati pojavu incidenata, poboljšati efikasnost i efektivnost radioterapijskog tretmana. Razvoj kulture sigurnosti ne podrazumijeva samo uspostavu standardnog seta pravila, nego i promjenu stavova, ponašanja i profesionalne prakse na individualnom i institucionalnom nivou.

Uvod: Lumbalni bolni sindrom podrazumijeva tegobe koje se javljaju u donjem dijelu leđa. Najčešći razlog je disfunkcija lumbosakralnog dijela kičme i zaštitna mišićna reakcija na bol. Tegobe koje nastaju u lumbalnom dijelu kičme u rasponu od nespecifičnog do diskogenog porijekla nose zajednički naziv lumbalni bolni sindrom. Cilj istraživanja je bio ispitati efikasnost dry needling tehnike uz ostale modalitete fizikalne terapije na intenzitet i katastrofiziranje bola i stepen onesposobljenja osoba s lumablnim bolnim sindromom. Metode istraživanja: Istraživanje je dizajnirano kao prospektivna randomizirana studija koja je upoređivala stanje ispitanika prije i nakon provedenog tretmana. Istraživanje je obuvatilo 35 ispitanika s lumbalnim bolnim sindromom oba spola, dobi od 25 do 83 godine i različitih zanimanja. Ispitanici su nakon provedenog fizikalnog pregleda započeli proces fizioterapijske rehabilitacije koja je obuhvatila Dry needling tehniku uz standardne modalitete fizikalne terapije: Interferentnu struju, terapijski ultrazvuk, LASER i kratkotalasnu dijatermiju. Terapijski protokol je trajao 10 dana u vremenskom periodu od dvije sedmice. Rezultati istraživanja: Analiza srednjih vrijednosti Vizualne analogne skale (VAS) i skale katastrofizacije bola (PCS) je pokazala značajno poboljšanje u odnosu na period prije terapije; VAS prije terapije 8,17, nakon terapije 3,06, PCS prije terapije 25,66, nakon terapije 9,11. Analiza Oswestry Disibility Index skale (ODI) je također pokazala značajno smanjenje srednjih vrijednosti stepena onesposobljenja ispitanika nakon provedenog terapijskog protokola; ODI prije terapije 52,00. nakon terapije 22,00. Zaključak: Dry needling tehnika uz standardne fizikalne procedure dovodi do smanjenja intenziteta i katastrofizacije bola, te smanjenja stepena onesposobljenja osoba s lumbalnim bolnim sindromom.

Uvod: Postoje značajni dokazi da djeca sa Diabetes mellitus-om tip 1 (DMT1) imaju niži kvalitet života od svojih zdravih vršnjaka. Holistički pristup pacijentu podrazumijeva razumijevanje kvaliteta života koji je od prognostičke važnosti za poboljšanje ublažavanja simptoma, zdravstvenu njegu i rehabilitaciju pacijenata. Zdravstvena njega usmjerena na porodicu je koncept koji je prihvaćen kao idealan model pružanja zdravstvene zaštite, posebno kod djece sa DMT1, jer je dokazano da je sudjelovanje majke u liječenju dijabetesa vlastite djece najvažnija odrednica za dobru kontrolu glikemije. Ciljevi rada: Ispitati faktore koji utiču na kvalitet života djece i adolescenata oboljelih od DMT1, istražiti podršku zdravstvenog sistema u Kantonu Sarajevo, te predložiti korektivne mjere na nivou porodice i zdravstvenog sistema u cilju poboljšanja kvaliteta života porodica sa djecom/adolescentima oboljelim od DMT1. Metode istraživanja: Tip studije je studija presjeka provedena deskriptivno analitičkom metodom. U studiju je uključeno 50 djece/adolescenata oboljelih od DMT1 i 50 primarnih njegovatelja sa područja Kantona Sarajevo. Provođenjem relevantnog broja instrumenata istraživanja, holistički se pristupilo detekciji problema sa kojima se susreću djeca i adolescenti oboljeli od DMT1. Rezultati: Bolji kvalitet života djece i adolescenata oboljelih od DMT1 je povezan sa boljom kontrolom glikemije, a kontrola glikemije kod djece i adolescenata značajno je povezana sa znanjem primarnog njegovatelja o dijabetesu. Podrška zdravstvenog sistema u Kantonu Sarajevo je nedostatna. Zaključak: Uvažavajući potrebu edukacije i savjetovanja djece/adolescenata i njihovih roditelja/staratelja, od velikog značaja bi bilo definisanje potreba za uključivanjem zdravstvenih profesionalaca, posebno medicinskih sestara specijalista za dijabetes i nutricionista, koji bi realizovali kako preventivne programe, tako i korektivne mjere na nivou porodice i zdravstvenog sistema i obezbijedili podršku porodicama djece i adolescenata oboljelih od DMT1.

Potassium metabisulfite is a white crystalline powder used in wine production and food preservation. Piperine is an alkaloid of the piperidine series and it is the main ingredient of black pepper. The aim of the present study was to evaluate the cyto/genotoxic effects of potassium metabisulfite and antimutagenic effect of piperine using the Allium test. To test the cyto/genotoxicity of potassium metabisulfite, three concentrations were used: 0.5, 1.0 and 2.0 g/L. To evaluate the antimutagenic effect of piperine, the following concentrations were applied: 3.3, 6.6 and 13.3 µL/mL. Our results demonstrated that all three tested concentrations of potassium metabisulfite significantly reduced root growth. Mitotic index values significantly decreased after the treatment with all three concentrations of potassium metabisulfite. An increased frequency of apoptotic cells was observed for the two highest concentrations of potassium metabisulfite, while a statistically different frequency of necrosis was detected for all three potassium metabisulfite concentrations in comparison with control. The total number of cytotoxic markers differed between all three potassium metabisulfite concentrations and control. A significantly higher frequency of sticky chromosomes for the two highest potassium metabisulfite concentrations, as well as an increased number of chromosomal bridges for median potassium metabisulfite concentration as compared to control group was determined. A significantly higher number of binuclear cells was detected for the highest potassium metabisulfite concentration. A significant difference between the two highest potassium metabisulfite concentrations and control was established for the total number of aberrant cells. As for the results for piperine, a reduction in the roots' growth was observed between the two highest piperine concentrations and negative control. The mitotic index decreased after treatment with all three piperine concentrations in comparison with negative and positive control. A significant difference in the frequency of apoptosis between median piperine concentration and positive control was detected. An increased frequency of necrosis between the two highest piperine concentrations and both controls was determined. The total number of cytotoxicity markers increased between the highest piperine concentration and both controls. A significantly higher frequency of chromosomal bridges between the two highest piperine concentrations and negative control was observed. The total number of aberrant cells differed between two highest piperine concentrations and negative control. This study demonstrated that potassium metabisulfite manifests antiproliferative, cytotoxic and genotoxic effects. Similarly, antiproliferative properties of piperine have been observed, while its antimutagenic potential has not been demonstrated. Further studies are needed to strengthen these observations.