The management of patients with acute pulmonary embolism (aPE) depend on the risk stratification at hospital admission. It is unknown when normotensive aPE patients with some other risk factors deteriorate. Patients with objectively established acute PE diagnosis enrolled in the regional PE registry from January 2015 to December 2021, were studied in this investigation. According to European Society od Cardiology criteria patients were stratified during admission to hospital in four risk stratums. The timing for death and the main reason for death were recorded. PE-related death was defined if patient has died because of cardiac arrest or obstructive shock if there is no another possible reason for that. In the REPER registry. Among 1541 patients (514 low risk, 366 intermediate-low risk, 472 intermediate-high risk and 189 high risk) with aPE, 101 (6.6%) have died primary from aPE and 64 (4.2%) have died from other reasons during the 30-day follow-up. PE-related death across the mortality risk groups were 0.8%, 1.1%, 8.5% and 28.5% in low-risk, intermediate-low, intermediate-high and high risk PE, respectively. Median time from hospital admission to PE related death was significantly longer in intermediate-high than in high risk patients 4.5 (2.0–9.0) vs 1.0 (1.0–4.5) days, p=0.001. In the high risk group 50.9% of patients died during the first 24 hours, 9.0% in the next 24 hours and 83.0% of patients died during the first 5 days from admission. In the intermediate-high risk group 17.5% died in the first 24 hours, 12.5% died in the next 24 hours and next 25% died till the fifth day. There was no difference in timing of non PE-related death between intermediate-high and high risk patients 9.5 (6.0–18.5) vs 7.0 (3.0–23.5) days, p=0.631. There is significant delay in timing of death in intermediate-high compare to high risk PE patients, however, almost 50% of patients who died in the intermediate-high risk PE patients have died inside the first 5 days from hospital admission. Type of funding sources: None.

Abstract Introduction Road traffic injuries (RTI) are among the ten leading causes of death worldwide, and they are the leading cause of death among young adults aged 15-29 years. In Federation of Bosnia and Herzegovina (FBiH), with population of 2,1 million, around 380 people die every year and additional 11.000 get seriously injured in RTI. Aim The aim of this study was to investigate the incidence and fatality rate of RTI in FBiH in the period of 2006 until the end of 2020. Methods Data source of RTI (ICD-X) incidence and fatality rate was Statistical book for Federation of Bosnia and Herzegovina, which includes all injuries and deaths reported through Ministry of internal affairs. Fatality rate was calculated as number of confirmed deaths in total number of reported RTI. To compare frequencies of reported deaths Chi square test was used. YLD were calculated based on information on injury that was caused in road traffic accidents. Results In the last 15 years, in FBiH, total 39,455 injuries related to road traffic were reported. According to the official data, over the period 2006-2020 the peak of fatality rate (8.52% deaths among all cases with RTI) was in 2016, while it had a statistically significant decline in 2018: 6.51%; 2019: 6.35%; and 2020: 6.32% (x2=7728,584; p < 0,0001). It is estimated that young adults (in the age group 30 to 39 years) injured in the road traffic accidents have 197.01 patient-years of total 881.17 years to live with disabilities just based on serious RTI in 2020. Conclusions RTI pose a significant burden on the health of the population in FBiH. After implementing strict laws in the year 2017, and 2018, a significant decrease of RTI was registered, including the number of deaths due to RTI (fatality rate). This abstract is support and sponsorship by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe. Key messages • RTI are significant burden for health of population in FBH. Strict laws and stronger punishments and fees are decreasing number of RTI. • This abstract is support and sponsorship by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe.

Abstract Background Mortality data are essential for monitoring population health and is one of the most important data for evaluation and comparison of health status at the local, national, and international level. Objective: We analysed all-cause mortality data in the Federation of Bosnia and Herzegovina (FBiH) for the period 2016-2021 and compared it with mortality occurred during the COVID-19 pandemic, in 2020 and 2021. Methods Using data on all-cause deaths for the period 2016-2021, obtained from the Institute for Statistics of the Federation of Bosnia and Herzegovina, we compared annual number of deaths (all-ages) and death rates during the 2020 and 2021 to pre-pandemic years. Results In 2016 the reported number of death was 21,146, in 2017 was 21,942, in 2018 was 21,691, and in 2019 was 22,024, and during the pandemic period in 2020 and 2021, 26,026 and 29,086 deaths were reported respectively. In 2020, 4,115 more deaths has been reported (15,8%), and in 2021 more 6,438 death (22,1%) compared with period 2016-2019. In FBiH in 2021, the death rate per 100,000 inhabitants was 1,341.2 and it is recorded an increase compared to 2020 when it had a value of 1,208.3 while in 2016 the value was 951.7. Conclusions A large proportion of increased mortality during pandemic was probably caused directly by COVID-19. However, the pandemic also resulted in deaths that would otherwise not have occurred (indirect deaths) due lack of access to medical services when hospitals were overwhelmed and changes in health seeking behaviour. An in-depth investigation of the underlying causes of the high excess mortality should be conducted to inform changes in the health care system and efforts to prevent severe COVID-19 through vaccination of vulnerable groups should be a priority. *This abstract is support by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe. Key messages • During the two years of the COVID-19 pandemic, population in FBiH had a significant increase in all-cause mortality. • The direct standardized death rate for all causes and age groups per 100,000 inhabitants in 2020 for FBiH was 818.0 and it is slightly higher compared to the EU average.

Aim To investigate the prevalence of burnout syndrome among health care workers in the Federation of Bosnia and Herzegovina (FBiH) during the coronavirus disease 2019 (COVID-19) pandemic. Methods This cross-sectional study was conducted in May and June 2021 using an online survey based on Copenhagen Burnout Inventory. The questionnaire underwent forward and backward translation, preliminary pilot testing, and was assessed for reliability and validity. Personal burnout, work-related burnout, and patient-related burnout were assessed. The survey was sent to the members of the Union of Physicians and Dentists in FBIH, who were asked to forward the link to their medical technicians and nurses. Results A total of 77% of participants experienced some form of burnout. As many as 32% experienced all three forms of burnout. Those actively involved in tackling the COVID-19 pandemic more often experienced burnout. In personal and work-related burnout domains, higher level of burnout was reported among female respondents. Higher work-related and patient-related burnout was reported by physicians compared with medical technicians/nurses. Higher level of patient-related burnout was reported in health care workers aged 30-39 and 50-59 years, among respondents working in primary care, and among physicians. Conclusion The majority of health care workers showed moderate or high levels of personal and work-related burnout, with a lower level of patient-related burnout. There is a need for further research into the causes of burnout, as well as for the implementation of organizational interventions aimed to minimize workplace burnout.

Background: Ischemic ECG changes are subtle and transient in patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS), yet the prehospital (PH)-ECG is not routinely used during subsequent evaluation at the emergency department (ED). We sought to compare the diagnostic performance of PH- and ED-ECG and evaluate the incremental gain of artificial intelligence (AI)-augmented ECG analysis. Methods: This prospective observational cohort study recruited patients with prehospital chest pain. We retrieved PH-ECG obtained by paramedics in the field and first ED-ECG obtained by nurses during in-hospital evaluation. Two independent and blinded reviewers interpreted ECG dyads in mixed order as per practice recommendations. Using 179 morphological ECG features, we trained, cross-validated, and tested a random forest classifier to augment NSTE-ACS diagnosis. Results: Our sample included 2,122 patients (age 59 (16); 53% females; 44% Black, 13.5% confirmed ACS). The rate of diagnostic ST elevation and ST depression were 5.9% and 16.2% on PH-ECG and 6.1% and 12.4% on ED-ECG, with ~40% of changes seen on PH-ECG persisting and ~60% resolving. Using PH-ECG alone gave poor baseline performance with AUROC, sensitivity, and negative predictive value of 0.69, 0.50, and 0.92. Using serial ECG changes enhanced this performance (0.80, 0.61, and 0.93). Interestingly, augmenting the PH-ECG alone with AI algorithms boosted its performance (0.83, 0.75, 0.95), yielding NRI of 29.5% against expert ECG interpretation. Conclusion: In this study, sixty percent of diagnostic ST changes resolved prior to hospital arrival, making the ED-ECG suboptimal for in-hospital evaluation of NSTE-ACS. Using serial ECG changes or incorporating AI-augmented analyses would allow correctly reclassifying one in four patients with suspected NSTE-ACS.

Helichrysum italicum (Roth) G. Don (Asteraceae), also known as immortelle, usually grows in the Mediterranean area. The composition of the essential oil (EO) of immortelle is a mixture of various aromatic substances, mainly monoterpenes and sesquiterpenes. Distillation is the most widely used method for extraction of EO immortelle, although the yield is very low (<1%). In this work, we aim to investigate how the use of different distillation methods affects the yield and chemical composition of immortelle EO. For this purpose, we applied two conventional methods: steam distillation (SD) and hydrodistillation (HD), and a modern (environmentally friendly) technique—microwave-assisted distillation (MAD). Wild immortelles from four different locations in Croatia were collected and carefully prepared for extraction. Each sample was then analyzed by gas chromatography–mass spectrometry (GC-MS). GraphPad Prisma statistical software was used to study the statistics between different groups of connections and analyze the data on the number of connections. The results show that HD gives a significantly higher yield (0.31 ± 0.09%) compared to MAD (0.15 ± 0.03%) and SD (0.12 ± 0.04%). On the other hand, the highest number of chemical compounds was identified with MAD (95.75 ± 15.31%), and most of them are subordinate compounds with complex structures. SD isolated EOs are rich in derived acyclic compounds with the highest percentage of ketones. The results show that the application of different distillation methods significantly affects the composition of the obtained immortelle EO, considering the yield of EO, the number of isolated, derived and non-derived compounds, chemotypes and compounds with simple (acyclic) and complex structures.

Background: Supernumerary teeth (ST) represent one of the most common developmental anomalies among humans. Objective: In this study, we set a goal to investigate ST prevalence in the Bosnian and Herzegovinian population along with characteristics and complications that ST can cause. Methods: This retrospective study was based on panoramic radiographs, CBCT images, and dental records. Analyzed ST characteristics were: type, morphology, location, eruption state, location in the arch, orientation, and associated clinical complications. Statistical analysis included univariate analysis and bivariate analysis using Fisher’s exact test with a confidence interval of 95% (p<0.05). Results: On a sample of 10.237 patients, ST teeth appear in 100 patients with a prevalence of 0.98%. Out of 138 analyzed ST mesiodens was the most frequent (43.47%). The most common location of the ST was maxilla (77.53%). The majority of ST were impacted (90.5%) but with no complications (71.7%). There was statistically significant relationship (p<0.001) between the type of ST and location (mesiodens and distomolars were mostly found in the maxilla). The relationship between ST type and morphology was also statistically significant (p<0.001)–mesiodens was associated with conical morphology, parapremolar with supplementary, and distomolar with tuberculate morphology. The occurrence of ST-associated retention of adjacent teeth was correlated to the type of tooth (p<0.001) Conclusion: The present study found prevalence of ST in B&H population to be low. Although associated pathology was not high early diagnosis allows optimal patient management which reduces later complications.

The paper analyzes the last Yugoslav television series A Better Life (Bolji život) the broadcast of which ended when the war had begun on the territory of the SFRY. More than thirty years after the end of the first broadcast of the series, it is still popular in Croatia, Bosnia and Herzegovina and Serbia, which is noticeable through numerous reruns, but also popularity on social networks, as well as numerous quotes from the series that are used in colloquial speech. The paper presents the content of the series and the main characters, as well as the most important secondary characters, briefly explains the then political and media situation in the different republics of the SFRY, which was completely uneven, which led to numerous antagonisms between nations, so in this context the series A Better Life was singled out as a series that was equally followed by citizens in all the republics, which was a phenomenon. In the context of today, the series is analyzed through the prism of Yugonostalgia, and the content of the series is analyzed through several themes that appear in the series: everyday life and rituals, dealing with the consequences of the economic crisis, the conflict between rural and urban among the residents of Belgrade, i.e. the so-called old Belgraders and so-called newcomers.Certain stereotypes appeared in the series, primarily gender stereotypes, that is, the roles of men and women in society were repeatedly pointed out through the dialogues. Although at the time of filming of Better Life, inter-ethnic relations in SFRY were in crisis, the screenwriter skilfully avoided national stereotypes, although they appeared in several scenes, which is also included in the analysis of the series. Although the series depicts a politically turbulent time, nowadays it is viewed almost romantically, as a chance for a lost better life and missed opportunities.