Abstract The purpose of this paper is to shed light on the biographical, professional, and health-educational works of Dr. Isak Samakovlija, who was better known as a writer than a doctor in the country where he was born. He was born in 1889 in Goražde, the easternmost province in the Austrian-Hungarian monarchy, into a modest Jewish merchant family. He attended high school in Sarajevo and completed his studies in medicine in Vienna in 1917. During the First World War, he served twice in the Austro-Hungarian army. After the end of the First World War in 1918, he completed a medical internship at the National Hospital in Sarajevo. He began his service as a doctor, first in Goražde and then in Fojnica and Sarajevo. After the establishment of the Independent State of Croatia in May 1941, he was dismissed from his duties in the service without the right to pension or support, and without the right to appeal. In the Independent State of Croatia, he was twice mobilized into the Home Guard and was manager of the clinic in the Alipašin Most refugee camp. After World War II, he was the head of the Health Education Department of the Ministry of Public Health of the People’s Republic of Bosnia and Herzegovina in Sarajevo. Together with a group of enthusiastic doctors, he founded and edited the first Bosnian medical journal Život i Zdravlje (Life and Health). In that journal, Dr. Samokovlija published 29 articles of health and educational content. In 1949, Dr. Samokovlija left the Ministry of Public Health and continued to edit the literature and art journal Brazda, but he still had a private practice until the end of his life. He died in Sarajevo on January 15, 1955. He was buried with the highest state honors at the Jewish cemetery in Sarajevo. Conclusion. Isak Samakovlija (1889-1955) was one of the first medical doctors born in Bosnia and Herzegovina. He made a significant contribution to the improvement of people’s health after the First and Second World Wars in the places where he worked. His special contribution are his articles on health education.

Background: During the process of the treatment of COVID-19 hospitalized patients, physicians still face a lot of unknowns and problems. Despite the application of the treatment protocol, it is still unknown why the medical status of a certain number of patients worsens and ends with death. Many factors were analyzed for the prediction of the clinical outcome of the patients using different methods. The aim of this paper was to develop a prediction model based on initial laboratory blood test results, accompanying comorbidities, and demographics to help physicians to better understand the medical state of patients with respect to possible clinical outcomes using neural networks, hypothesis testing, and confidence intervals. Methods: The research had retrospective-prospective, descriptive, and analytical character. As inputs for this research, 12 components of laboratory blood test results, six accompanying comorbidities, and demographics (age and gender) data were collected from hospital information system in Sarajevo for each patient from a sample of 634 hospitalized patients. Clinical outcome of the hospitalized patients, survival or death, was recorded 30 days after admission to the hospital. The prediction model was designed using a neural network. In addition, formal hypothesis tests were performed to investigate whether there were significant differences in laboratory blood test results and age between patients who died and those who survived, including the construction of 95% confidence intervals. Results: In this paper, 11 neural networks were developed with different threshold values to determine the optimal neural network with the highest prediction performance. The performances of the neural networks were evaluated by accuracy, precision, sensitivity, and specificity. Optimal neural network model evaluation metrics are: accuracy = 87.78%, precision = 96.37%, sensitivity = 90.07%, and specificity = 62.16%. Significantly higher values (P < 0.05) of blood laboratory result components and age were detected in patients who died. Conclusion: Optimal neural network model, results of hypothesis tests, and confidence intervals could help to predict, analyze, and better understand the medical state of COVID-19 hospitalized patients and thus reduce the mortality rate.

SUMMARY Antibiotic therapy is indicated during acute cholecystitis. However, in the treatment of uncomplicated cholelithiasis, prophylactic use of antibiotics is controversial. Microbiological and laboratory data are the basis for the choice of antibiotic treatment. However, monitoring and updating local antibiograms is important because they ensure effective therapy in the given clinical environment. The study included 110 consecutive patients who underwent laparoscopic cholecystectomy, divided into the group of uncomplicated cholelithiasis (n=60) and the group of acute cholecystitis (n=50). Preoperative data included age, sex, body mass index, leukocytes, C-reactive protein, and ultrasound examination. Bile samples for bacteriological testing were obtained under aseptic conditions during the surgery. Cultures were evaluated for aerobic, anaerobic and fungal organisms using routine tests. After the surgery, gallbladder specimens were sent for histopathological examination. In the group of uncomplicated cholelithiasis, 6/60 positive samples were found, and in the group of acute cholecystitis, there were 25/50 positive microbiological findings. Citrobacter sp. and Enterococcus faecalis predominated in the group of uncomplicated cholelithiasis, and Escherichia coli, Enterococcus faecalis, Proteus mirabilis and Citrobacter sp. in the group of acute cholecystitis. Antibiotics were administered to 49/50 patients with acute cholecystitis and to 32/60 patients with uncomplicated cholelithiasis. Cefazolin was the most frequently used antibiotic and also the most resistant antibiotic. To conclude, the administration of antibiotics in elective patients is not justified. The results of this study indicate that third-generation cephalosporin or ciprofloxacin + metronidazole should be administered in mild and moderate acute cholecystitis, and fourth-generation cephalosporin + metronidazole in severe acute cholecystitis in this local setting. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.

Objective. The aim of this study was to learn about the morphological characteristics of the supraorbital foramen and to determine its precise position in relation to the surrounding anatomical landmarks in the adult population of Bosnia and Herzegovina. Material and Methods. For this purpose, 60 skulls from the Bosnia and Herzegovina population of known sex (32 males and 28 females), taken from the osteological collection of the Department of Human Anatomy of the Medical Faculty in Sarajevo, were subjected to morphological and morphometric analysis. Morphometric measurements were performed using a digital vernier caliper (Mitutoyo Corporation, Japan). Results. The study showed that most supraorbital nerves exit the orbit through the supraorbital notch (73.8%) and the rest through the foramen (26.2%). Of this number, bilateral supraorbital notches were recorded in 58.33% of cases, a bilateral supraorbital foramen in 18.34% of cases, while in 23.33% of cases a notch was recorded on one side and a foramen on the contralateral side. Morphometric measurements performed to determine the exact position of the supraorbital foramen relative to the surrounding landmarks showed different values in males and females. An accessory foramen was also observed on the examined skulls in 16.67% of cases. Conclusion. Detailed knowledge of anatomical variations of the supraorbital foramen is required for safe and successful administration of regional anesthesia, in order to avoid iatrogenic nerve injuries during orbitofacial region surgery.

Aim To evaluate clinical and epidemiological characteristics and outcome of patients with COVID-19, and impact of vaccine against COVID-19 on them. Methods This retrospective study included 225 patients treated from COVID-19 in the period from 1 to 30 September 2021 at the Clinic for Infectious Diseases, University Clinical Centre Tuzla (UCC Tuzla). For the diagnosis confirmation of Covid-19, RTPCR was used. Patients were divided in two groups: fully vaccinated with two doses of vaccine, and non-vaccinated or partially vaccinated. Results Of 225 patients, 120 (53.3%) were females, and 105 (46.7%) males. Mean age was 65.6 years. There were 26 (11.6%) fully vaccinated patients. Most common symptoms in unvaccinated patients were fatigue (70.9%), cough (70.4%) and fever (69.8%), and in vaccinated fever (76.9%), fatigue (69.2%) and cough (46.2%). Cough was more common in unvaccinated patients (p=0.013). Fatal outcome happened in 84 (37.3%) patients. Transfer to the Intensive Care Unit (ICU) and older age had a higher risk of death (p<0.001). Older age patients were more likely to have comorbidities like atrial fibrillation (p=0.017), hypertension (p<001) and diabetes mellitus (p=0.002). Atrial fibrillation (p<0.001), hypertension (p<0.001), diabetes mellitus (p=0.009) and history of stroke (p=0.026), were related to fatal outcome in unvaccinated patients, also did a shorter duration of illness prior to hospitalization (p<0.001) and shorter length of hospitalization (p=0.002). Conclusion Older patients with comorbidities, as well as those who were not vaccinated against COVID-19, were at higher risk for severe form of the disease and poor outcome.

Background: Despite many advances in the prevention, of sternal wound infection, especially deep ones, cardiac surgery with median sternotomy, still presents a significant postoperative complication. Numerous operative and non-operative procedures should be used in treatment, there is a prolonged hospital stay and increased hospital costs treating this postoperative complication. Objective: The present study was conducted aiming to determine the incidences, and risk factors, identify microbiology findings, and antibiotic therapy among patients with DSWI who underwent cardiac surgery with median sternotomy at our Clinic and VAC treatment. Methods: This retrospective observational study was conducted in Clinic for Cardiovascular Surgery at University Clinical Center Sarajevo from November 2015 to November 2020. The data were obtained from 15 patients with deep sternal wound infection (DSWI) following open-heart surgery. The inclusion criteria were DSWI after cardiac operation via median sternotomy, and complete results of microbiological findings obtained by sternal swab. The exclusion criteria were patients with incomplete clinical data. Results: We found that 9 (60%) patients were males and 6 (40%) were females. Coronary artery bypass grafting (CABG) operation had 11 (73,3%) patients, CABG with aortic valve replacement 2 (13,3%), valve replacement surgery operations (13,3%). The average age was 66 years. All patients were elective surgery patients. STS score in the Non-VAC group was 22.6, in the VAC group 16.6, and the average was 14.9. The number of patients with DSWI represents 1% of all sternotomy patients in the observed period. Two risk factors for DSWI had 37% of patients, 25% of them were diabetic, and 3 (9%) were overweight. Enterococcus faecalis was isolated predominantly in 6 (27%) patients, followed by Klebsiella pneumonia 3 (13%), Proteus mirabilis 2 (9%), and Serratia Maecenas 2 (9%). The mortality rate was 33.3% (5 of 15). Conclusion: The results of our study present our experience with DSWI treatment after open-heart surgery. What comes from our experience so far, is that is very important to determine patients who are at risk of developing DSWI after cardiac surgeries to lower its incidence.

Aim To investigate bystanders' CPR involvement in out-of-hospital cardiac arrest (OHCA) events, their current knowledge regarding OHCA and BLS measures, their willingness to learn BLS measures with the usage of AEDs, as well as current practices. Methods This cross-sectional study included: data regarding all OHCA events treated at the Emergency Medical Service of Canton Sarajevo between January 2015 and December 2019, and an online anonymous questionnaire that examined knowledge, attitudes and practices regarding basic life support (BLS) and automated external defibrillators (AEDs). Results A total of 328 (24.0 %) of 1362 OHCA events achieved the return of spontaneous circulation (ROSC). OHCA incidence was 62/100.000 inhabitants per year. Male gender (p=0.043) and younger age (p<0.001) were significantly associated with obtaining ROSC. Only 44 (3.2%) OHCA events were assisted by bystanders, who were mostly medical professionals 38 (86.4%), followed by close family members 6 (13.6%). There was no report of AED usage. BLS and AED knowledge test score was in the range 12.0-89.8% with generally poor knowledge. Our residents agreed that BLS measurements are essential, 1604 (86.7 %) and that BLS should be a part of their curriculum, 1678 (90.7 %). Conclusion The prevalence of OHCA events in Bosnia and Herzegovina is similar to the region; ROSC among OHCA events was lower than European average, but among highest in the region. There was an extremely low rate of bystander engagement and no AEDs usage. Governmental institutions and health agencies should intervene to increase population knowledge thus increasing OHCA survival rate.

Background: Two-dimensional echocardiography (2DE) Simpson methods is the most frequently used imaging modality to assess Left ventricular ejection fraction (LVEF). LVEF is an important predictor of morbidity and mortality in a wide range of patients and clinical scenarios. Despite its importance in prognosis and clinical decision making, most echocardiography laboratories currently determine EF primarily by visual estimation, which is highly experience-dependent and sensitive to intra- and inter-observer variability and suboptimal accuracy and repeatability. Over the last decade, 3-dimensional echocardiography (3DE) has become increasingly implemented in clinical practice. The automated 3D HeartModelA.I. tracks every frame over the cardiac cycle using 3D speckle technology. HeartModelA.I. is a fully automated program that simultaneously detects LA and LV endocardial surfaces using an adaptive analytics algorithm that consists of knowledge-based identification of initial global shape and orientation followed by patient-specific adaptation. Objective: The objective of the study was to compare the automated 3D HeartModelA.I echocardiography and 2D Simpson methods echocardiography in evaluation of the left ventricular ejection fraction and left ventricular volumes in patients with left heart dysfunction. Methods: The study prospectively enrolled 165 patients with symptoms of LV dysfunction (ischemic or nonischemic) and New York Heart Association (NYHA) functional class I-III, referred for an echocardiographic study to evaluate the LV volumes and LV ejection fraction (LVEF) during the period from March 2020 to March 2022. Echocardiographic images were acquired by experienced echocardiographers using a commercially available Philips EPIQ machine (Koninklijke Philips Ultrasound, USA) equipped with X5-1 Matrix probe for 2DE and DHM 3DE acquisitions, respectively. Results: 2D Simpson methods echocardiography results for estimated LVEF were 38.43 ± 1.70 in patients with NYHA class I-II, 30.53 ± 1.60 in patients with NYHA class III. Using 3D Heart Model, LVEF were 38.23 ± 1.71 in patients with NYHA class I-II and 30.27 ± 1.50 in patients with NYHA class III. The results of 2D Simpson methods echocardiography for estimated LVEDVi in NYHA class I-II and NYHA class III were 99.06 ± 6.36 ml/m2, 121.96 ± 2.93 ml/m2 respectively, LVESVi were 60.91 ± 3.91 ml/m2, 84.74 ± 2.70 ml/m2 respectively, for 3D Heart Model, LVEDVi in NYHA class I-II and NYHA class III were 100.07 ± 6.72, 121.38 ± 3.01 ml/m2 respectively, LVESVi were 61.75 ± 3.94 ml/m2, 84.73 ± 2.33 ml/m2 respectively. 2DE measurement of LV volumes and EF was completed in 6.1 ± 0.8 min. per patient. 3DE HeartModelA.I acquisition and analysis in most patients was completed in <3.2 min., an average time of 2.9 ± 1.3 min. per patient. The result of our study shows that the 3D HeartModelA.I. is a reliable and robust method for LVEF and LV volume analysis, which has similar results to 2D echocardiography performed by experienced sonographers. In this study, we found that 3DE DHM fully automated tool is also significantly faster than 2DE analysis and thus can help overcome the time-consuming nature and its present a strong argument for its incorporation into the clinical workflow. In this study, we found that 3DE DHM fully automated tool is also significantly faster than 2DE analysis and thus can help overcome the time-consuming nature and its present a strong argument for its incorporation into the clinical workflow. Conclusion: 3D DHM provides fast and accurate LV volumes and LVEF quantitation, as it avoids geometric assumptions and left ventricular foreshortening, has better reproducibility and has incremental value to predict adverse outcomes in comparison with conventional 2DE. In the future major benefit of AI in echocardiography is expected from improvements in automated analysis and interpretation to reduce workload and improve clinical outcome.

Obstetric shock (OS) has been defined as a life-threatening cardiovascular collapse syndrome associated with pregnancy, childbirth and puerperium (obstetrics causes), and is the most significant cause of high maternal mortality (MM) throughout human history. Shock in obstetrics (SIO) refers to indirect causes of non-obstetrics causes in pregnancy, childbirth and puerperium (polytrauma, aesthetic incidents, cardiovascular or cerebrovascular incidents, other septic syndromes). The goals of OS treatment are: to quickly detect the location or cause of bleeding / injury / inflammation, prevent the progression of shock, prevent massive transfusions, preserve the uterus (and adnexa), and preserve fertility if possible. Surgical treatment of septic shock includes exploratory laparotomy (laparoscopy), ectomy or resection of the necrotized organ, abdominal lavage with multiple drainages, continuous peritoneal drainage with lavation, extensive triple antibiosis per admission or per antibiogram and thromboprophylaxis. OS seems to remain a permanent miasma in practical clinical obstetrics, which we will not be able to influence, because we have obviously caused today's increase in MM from haemorrhagic OS by iatrogenic increase in the number of caesarean sections, especially elective ones.

Objectives Evidence on the current status of gender equity in academic rheumatology in Europe and potential for its improvement is limited. The EULAR convened a task force to obtain empirical evidence on the potential unmet need for support of female rheumatologists, health professionals and non-clinical scientists in academic rheumatology. Methods This cross-sectional study comprised three web-based surveys conducted in 2020 among: (1) EULAR scientific member society leaders, (2) EULAR and Emerging EULAR Network (EMEUNET) members and (3) EULAR Council members. Statistics were descriptive with significance testing for male/female responses assessed by χ2 test and t-test. Results Data from EULAR scientific member societies in 13 countries indicated that there were disproportionately fewer women in academic rheumatology than in clinical rheumatology, and they tended to be under-represented in senior academic roles. From 324 responses of EULAR and EMEUNET members (24 countries), we detected no gender differences in leadership aspirations, self-efficacy in career advancement and work–life integration as well as the share of time spent on research, but there were gender differences in working hours and the levels of perceived gender discrimination and sexual harassment. There were gender differences in the ranking of 7 of 26 factors impacting career advancement and of 8 of 24 potential interventions to aid career advancement. Conclusions There are gender differences in career advancement in academic rheumatology. The study informs a EULAR task force developing a framework of potential interventions to accelerate gender-equitable career advancement in academic rheumatology.

Addressing factors modulating COVID-19 is crucial since abundant clinical evidence shows that outcomes are markedly heterogeneous between patients. This requires identifying the factors and understanding how they mechanistically influence COVID-19. Here, we describe how eleven selected factors (age, sex, genetic factors, lipid disorders, heart failure, gut dysbiosis, diet, vitamin D deficiency, air pollution and exposure to chemicals) influence COVID-19 by applying the Adverse Outcome Pathway (AOP), which is well-established in regulatory toxicology. This framework aims to model the sequence of events leading to an adverse health outcome. Several linear AOPs depicting pathways from the binding of the virus to ACE2 up to clinical outcomes observed in COVID-19 have been developed and integrated into a network offering a unique overview of the mechanisms underlying the disease. As SARS-CoV-2 infectibility and ACE2 activity are the major starting points and inflammatory response is central in the development of COVID-19, we evaluated how those eleven intrinsic and extrinsic factors modulate those processes impacting clinical outcomes. Applying this AOP-aligned approach enables the identification of current knowledge gaps orientating for further research and allows to propose biomarkers to identify of high-risk patients. This approach also facilitates expertise synergy from different disciplines to address public health issues.

We studied the efficiency of three culture series of the microalgae Phaeodactylum tricornutum (P. tricornutum) and bacteria Thalassospira sp. (axenic microalgae, bacterial culture and co-culture of the two) in removing bisphenols (BPs) from their growth medium. Bacteria were identified by 16S ribosomal RNA polymerase chain reaction (16S rRNA PCR). The microorganism growth rate was determined by flow cytometry. Cultures and isolates of their small cellular particles (SCPs) were imaged by scanning electron microscopy (SEM) and cryogenic transmission electron microscopy (Cryo-TEM). BPs were analyzed by gas chromatography coupled with tandem mass spectrometry (GC-MS/MS). Our results indicate that some organisms may have the ability to remove a specific pollutant with high efficiency. P. tricornutum in axenic culture and in mixed culture removed almost all (more than 99%) of BPC2. Notable differences in the removal of 8 out of 18 BPs between the axenic, mixed and bacterial cultures were found. The overall removals of BPs in axenic P. tricornutum, mixed and bacterial cultures were 11%, 18% and 10%, respectively. Finding the respective organisms and creating microbe societies seems to be key for the improvement of wastewater treatment. As a possible mediating factor, numerous small cellular particles from all three cultures were detected by electron microscopy. Further research on the mechanisms of interspecies communication is needed to advance the understanding of microbial communities at the nano-level.