Aim Compare the efficacy of nebulized hypertonic saline and normal saline in the treatment of infants hospitalized for bronchiolitis. Methods This retrospective study was conducted at the Department of Pulmonology, Paediatric Clinic, Clinical Centre University of Sarajevo, covering the period from January 2015 to December 2019 and comprising 380 children aged between 1 and 12 months having bronchiolitis. One group received nebulized hypertonic saline (NHS, 3% NaCl)), and another group received nebulized normal saline (NNS, 0.9% NaCl). The control group did not receive any of these treatment options. Results There was no statistically significant difference between the treatment groups regarding length of hospital stay (LOS) and Clinical Severity Score (CSS) at admission and discharge as well as in oxygen therapy duration and antibiotic use, the duration of symptoms before hospital admission, frequency of nasal discharge, elevated temperature, dyspnoea, cough and dehydration. Conclusion The results of this study are consistent with several recent studies or meta-analyses and support the evidence against the use of NHS in hospitalized infants with mild or moderate bronchiolitis.

Aim To identify clinical and laboratory parameters on admission and/or during a hospital stay that would predict prolonged hospital stay in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A retrospective cross-sectional study was conducted at the Clinic for Pulmonary Diseases and Tuberculosis, Clinical Centre University of Sarajevo for the period 2019-2021 accounting patients admitted due to AECOPD. The need for hospitalization was evaluated according to the current GOLD criteria and certain clinical parameters. Spirometry testing and laboratory analysis were performed for all patients on the day of admission and on the 10th day of hospital stay. Linear regression was used to show the relationship between multiple independent predictor variables and LOS. Results A total of 50 patients were evaluated during their hospital stay due to AECOPD. Median of LOS was 22.02±1.06, with 90% hospital survival rate. Due to AECOPD the median of LOS in the intensive care unit (ICU) was 4±0.68 days with pH<7.35 in 34% of hospitalized patients. According to spirometry classification on the day of admission, 56% of patients were assigned to group 3 and 16% to group 4 with significant improvement identified on spirometry findings on discharge. Platelets on the day of admission were the only statistically significant positive predictors of the length of hospital stay. Conclusion Identifying chronic obstructive pulmonary disease patients at risk of frequent exacerbations and appropriate disease management could reduce the disease burden.

Background: Consuming a diet rich in natural foods that include oilseed products containing bioactive compounds and a diverse array of fatty acids is not just a dietary choice; it is a critical element of maintaining human health. Objective: This paper aims to review the current state of knowledge on minor bioactive compounds in vegetable cold pressed oils, these are substances that are found in small amounts in vegetable cold pressed oils. Methods: Intended as an indispensable resource, this review is designed to empower medical professionals in the fields of integrative medicine, nutrition, and dietetics. Results and Discussion: Cold-pressed oils extracted from various plant sources have emerged as vital allies in the battle against inflammation-related diseases, offering a versatile range of valuable compounds. These compounds contribute to the oils' multifaceted properties, which encompass potent anti-inflammatory, antioxidant, and anticancer effects, greatly enhancing their nutritional significance. This brief review delves deep into the intricate composition of cold-pressed oils, with a specific focus on the often overlooked but highly influential minor bioactive compounds, including phytosterols, phospholipids, tocols, phenols, squalene and pigments. Intended as an indispensable resource, this review is designed to empower medical professionals in the fields of integrative medicine, nutrition, and dietetics. It equips them with a wealth of knowledge to guide consumers in making informed choices when incorporating cold-pressed oils into their dietary plans, tailored to their individual health needs.. Conclusion: This paper highlights the importance of cold-pressed oils as a source of various minor bioactive compounds that have the potential to promote human health and prevent or manage a range of diseases. The findings presented in this paper serve as a valuable resource for medical professionals in the field of integrative medicine, nutrition, and dietetics, as well as for consumers looking to make informed choices about their dietary and health needs.

Background: Metabolic syndrome (MetS) denotes a cluster of co-occurring medical conditions associated with regulating hyperglycemia and acute cardiovascular events and complications. The escalating frequency of MetS among individuals afflicted with type 2 diabetes mellitus (T2DM) underscores its burgeoning significance as a critical public health concern and a complex clinical conundrum. Timely identification is imperative to avert the expedited progression of diabetic complications. Objective: To investigate the role of CRP/HDL-C and Monocyte/HDL ratios in predicting MetS in T2DM individuals. Methods: The study was designed as a two-year prospective study and included 80 T2DM patients divided into MetS and non-MetS groups based on MetS development over two years. The patients’ serums were analyzed for complete blood count parameters, lipid profile, and C-reactive protein (CRP). Based on the laboratory test results, Monocyte/HDL-C and CRP/HDL-C ratios were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy. Results: Monocyte/HDL-C ratio and CRP/HDL-C ratio were significantly higher in MetS-T2DM2 than in nonMetS-T2DM (p=0.003 and p=0.029, respectively). The results of ROC curve analysis have shown that the CRP/HDL-C ratio (AUC of 0.695) and Monocytes/HDL-C ratio (AUC of 0.645) can serve as good predictors of MetS in T2DM patients. Conclusion: This study confirms the reliability of the Monocytes/HDL-C and CRP/HDL-C ratios as novel, simple, low-cost, and valuable predictors of MetS development in T2DM.

Background: Acute pancreatitis (AP) is an acute inflammatory illness of the pancreas representing a true question in diagnostic process. Laboratory markers of the hepatobiliary tract such as liver transaminases with pancreatic enzymes give a true hint of a hidden diagnosis together with urea, creatinine and creatine kinase (CK). Objective: This clinical study aims to show whether there is any correlation between alpha-amylase and CK or their ratio examining hospitalized patients with AP diagnosis. Methods: From total number of 99 patients with a clinical picture of AP, 71 patients in this retrospective analysis (including both genders) were included according to the presence of two biochemical markers in collected laboratory analysis at admission and 72 hours later on a laboratory check-up: CK and alpha-amylase. Results: The median CK value of AP cases was 92 (41.75 – 207.25) in the acute period and 73 (37 – 159) after 72h staying in the hospital without statistical significant (p=0.521; p<0.05). However, there was a statistically significant correlation between the parameters of CK at admission and creatine kinase after 72h staying in the hospital. The median value of CK/Amylase ratio in the acute period was 0.168 (0.069 – 0.532) and 0.386 (0.12 – 1.12) after 72 hours of staying in the hospital. There was a statistically significant difference between values of CK/amylase ratio in these two groups (p=0.000; p<0.01). Conclusion: In conclusion, a connection between CK and alpha-amylase needs to be elucidated in further studies and its existence must be researched both in physiological and pathophysiological conditions, and it is two-way and very complex. This study helped us obtain significant information about the perspective of AP in the potential relation to other non-standard laboratory markers for some diseases

Background: Endocrine-disrupting chemicals (EDCs) represent a group of chemicals which are related to the disturbances in the human hormonal system. Due to the newest research, it was discovered that their actions did not exclusively point to the hormonal system but rather to all organs of the human body. EDCs are metabolized and may excrete the influence on human metabolism. That influence can be related to the activity of different enzymes included in human metabolism. Those effects can be classified as epigenetic effects. Objective: The aim of the study was to make analysis, evaluation, examination and determination of the possible mechanisms through which EDCs may interact with different metabolically-driven diseases. Methods: This paper represents a review article that includes original and review articles that were used being published in the following databases: Medline/PubMed, ScienceDirect, Oxford Academic, and Google Scholar. Results: EDCs interact through nuclear or steroid receptors excreting their influence onto diseases such as obesity, metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD). Those mechanisms are mediated through metabolic or immunological pathways. It encompasses different types of hormones, such as vistafin or inflammatory cytokines. Conclusion: It has been noticed that EDCs may influence the appearance of specifically related diseases in offspring excreting epigenetic effects. Further research must be oriented towards potential consequences and ideal pathways for prevention and treatment options.

Introduction: Diabetes mellitus type 2 (T2DM) significantly increase the risk of cardiovascular (CV) disease morbidity and mortality. This study aimed to evaluate the potential of some novel anthropometric indices and adipocytokines to evaluate CV risk among T2DM patients. Methods: A total of 112 patients (men, 57; women, 55) with T2DM visiting Family Medicine and Endocrine counseling in the area of Health centers of Sarajevo Canton were included in this study. The sera samples were analyzed for fasting blood glucose (FBG), HbA1c, lipid profile parameters, adiponectin, and resistin levels. The Adiponectin/Resistin Index (A/R Index) was estimated using the formula. The novel anthropometric measurements, including the Conicity index (CI), Lipid Accumulation Product (LAP), visceral adiposity index (VAI), abdominal volume index (AVI), and Body adiposity index (BAI) were estimated. The 10-year risk for coronary heart disease (CHD) and fatal coronary heart disease (fCHD) is calculated by using UKPDS Risk software. Results: The adiponectin was shown as a statistically significant negative association with CHD in female subjects, and the A/R index as a statistically significant association with CHD and fCHD in male subjects. The AVI is superior to the CI, LAP, VAI, and BAI in assessing cardiometabolic risk in T2DM patients. Conclusions: Our study indicated that measuring adiponectin and A/R index, together with measuring AVI as a measure of general volume, can be used as surrogates in the evaluation of high cardiovascular risk among T2DM patients.

Introduction: Diabetes mellitus type 2 (T2DM) significantly increase the risk of cardiovascular (CV) disease morbidity and mortality. This study aimed to evaluate the potential of some novel anthropometric indices and adipocytokines to evaluate CV risk among T2DM patients. Methods: A total of 112 patients (men, 57; women, 55) with T2DM visiting Family Medicine and Endocrine counseling in the area of Health centers of Sarajevo Canton were included in this study. The sera samples were analyzed for fasting blood glucose (FBG), HbA1c, lipid profile parameters, adiponectin, and resistin levels. The Adiponectin/Resistin Index (A/R Index) was estimated using the formula. The novel anthropometric measurements, including the Conicity index (CI), Lipid Accumulation Product (LAP), visceral adiposity index (VAI), abdominal volume index (AVI), and Body adiposity index (BAI) were estimated. The 10-year risk for coronary heart disease (CHD) and fatal coronary heart disease (fCHD) is calculated by using UKPDS Risk software. Results: The adiponectin was shown as a statistically significant negative association with CHD in female subjects, and the A/R index as a statistically significant association with CHD and fCHD in male subjects. The AVI is superior to the CI, LAP, VAI, and BAI in assessing cardiometabolic risk in T2DM patients. Conclusions: Our study indicated that measuring adiponectin and A/R index, together with measuring AVI as a measure of general volume, can be used as surrogates in the evaluation of high cardiovascular risk among T2DM patients.

Abstract Background: Low-grade chronic inflammation is an important feature of chronic kidney disease (CKD). Aim: To determine the values of C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with different stages of CKD and to examine how they change depending on the progression of renal damage. Materials and methods: A cross-sectional descriptive comparative study included 157 subjects at different stages of CKD which was assessed based on glomerular filtration rate (GFR) calculated according to the MDRD equation. CRP was analyzed by an immunoturbidimetric method. NLR and PLR were calculated by a mathematical calculation after a blood count was performed. Results: The present study showed an increase in serum creatinine, CRP, and NLR values with progression of renal failure. There was a statistically significant difference in the creatinine and CRP concentrations between groups with different stages of CKD (p <0.001 for all comparisons). A significant positive correlation was found between NLR and CRP, while negative, significant correlations were observed between NLR and eGFR as well as between PLR and eGFR. There was a slight increase in PLR value with the progression of renal impairment, but the correlation between PLR and CRP was not significant. Conclusion: These results suggest that NLR, together with CRP, may serve as an indicator of systemic low-grade inflammation progression in patients with CKD. Larger prospective studies are required to observe the possibility of using NLR as a surrogate marker for CRP in patients with CKD.

Objective: This study aimed to determine the intravitreal concentration of VEGF in eyes with PDR and to evaluate the effects of previous PRP on its level. Methods: It was a cross-sectional study performed at the Clinical Centre University. It included 90 eyes surgically treated with PPV, divided into three groups, group A - patients with PDR with previous PRP, group B - patients with PDR without previous PRP, and group C - PPV performed due to the indication unrelated to diabetes. A vitreous sample was obtained during PPV, and the VEGF concentration was determined using an Enzyme-linked immunosorbent assay test (ELISA). Shapiro-Wilk, nonparametric tests Kruskal-Wallis, Mann-Whithney U test, ANOVA and Spearman’s correlation test were used. Results: The highest vitreous VEGF concentration was in group B - 972.96 (743.33-1149.13) and was higher than in group A - 69.22 (37.33-225.15) and in group C - 19.93 (1.15-32.17) (p<0.001). There was a positive correlation between VEGF vitreous concentration and glucose level in group A patients (Rho=0.410; p=0.027). Conclusion: As a treatment before PPV surgery, PRP showed to be effective in the reduction of VEGF levels, which also highlighted a decrease in complications during and postoperatively. Abbreviations: DRS = Diabetic Retinopathy Study, PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, PRP = pan-retinal photocoagulation, PPV = pars plana vitrectomy, HbA1c = glycosylated hemoglobin, ETDRS = Early treatment diabetic retinopathy study, ESR = erythrocyte sedimentation rate, BCVA = best corrected visual acuity, OCT = optical coherent tomography, ILM = internal limiting membrane, PHACO = phacoemulsification, IOL = intraocular lens, ELISA = Enzyme-linked immunosorbent assay test, AUC = area under the curve, DME = diabetic macular oedema, TDR = tractional retinal detachment, VMT = vitreomacular traction

Objective. To identify the type of the non-invasive ventilatory treatment for patients diagnosed with chronic obstructive pulmonary disease (COPD), with respiratory status deteriorated by COVID-19 pneumonia, and in need of treatment in the Intensive Care Unit (ICU). Materials and Methods. This cross-sectional study was conducted over a one-year period in the medical intensive care units of two hospitals. As the patients’ clinical condition deteriorated and the parameters of the arterial blood gas (ABG) analysis worsened, oxygen support was applied via a high flow nasal cannula (HFNC) or by non-invasive positive pressure ventilation (NPPV). According to the control values of the arterial oxygen saturation (SaO2) and the parameters of ABG, the patients were enabled to be transferred between the two types of non-invasive ventilatory support. The primary outcome was the length of hospital stay, while secondary outcomes were the rate of intubation, the mortality rate, and respiratory support-free days. Results. Out of 21 critical patients with COPD and COVID-19, 11 (52.4%) were initially treated with NPPV and 10 (47.6%) with HFNC. The ages (67±9.79 in NPPV group vs. 70.10±10.25 in HFNC group) and severity of illness (SOFA score 5 (3.5) in NPPV group vs. 5 (2.8) in HFNC group) were similar between the two groups. Switching the mode of respiratory support was more common in NPPV (58.3% in survivor group vs. 41.7% in non-survivor group). Patients treated with NPPV compared to HFNC had a nominally longer length of stay (15 (11) vs. 11.5 (4.25)), and higher risk of intubation (66.7% vs. 33.3%) and mortality (66.7% vs. 33.3%), but the comparisons did not reach statistical significance. Survivors had significantly longer Medical Intensive Care Unit and hospital stays, but significantly lower FiO2 (0.60 vs.1) and higher values of PaO2/FiO2 (78(32.4) vs. 56.3(17.8)) than non-survivors. All patients were treated with corticosteroids, and the duration of treatment was similar between groups. Conclusion. In critically ill patients with COPD and COVID-19, both HFNC and NPPV were commonly used as the initial mode of ventilation. Switching to a different mode and adverse patient outcomes were more frequent in patients initially treated with NPPV. Survivors had higher values of PaO2/FiO2 than non-survivors.

Objective The imbalance of antioxidants and pro-oxidants plays a crucial role in the carcinogenesis of bladder cancer (BC). This study aimed to evaluate serum antioxidant status in patients with BC and determine its potential use in the diagnosis and progression potential considerations following histopathological assessment. Methods A cross-sectional study included 90 patients with BC, divided into Ta, T1, and T2–T4 stage subgroups, and according to cancer progression potential, into low-grade (LG) and high-grade (HG) subgroups. The control group (CG) included 30 healthy volunteers. Antioxidant status was determined using the spectrophotometric method and standard laboratory tests. Results Serum superoxide dismutase activity was significantly higher in BC patients regarding cancer stage in comparison to the CG (p<0.001). Catalase activity was highest in T2–T4 subgroup and was significantly higher compared to the Ta (p<0.01) and T1 (p<0.05) subgroups. Serum albumin level was significantly lower in the BC group compared to the CG (p<0.001). In addition, it was significantly lower in T2–T4 subgroup compared to T1 and Ta subgroups (p<0.01). A significant negative correlation was found between tumor size and serum albumin level only (r=−0.386, p<0.01). Catalase activity was higher in HG subgroup (p=0.009), while bilirubin level was higher in LG subgroup (p=0.035). The optimal cut-off value of catalase activity in differentiating patients with LG and HG BC subgroups was ≥11.96 IU/L, and the specificity and sensitivity were 51.1% and 82.2%, respectively. Bilirubin level, for a calculated optimal cut-off value of ≥11.95 μmol/L, had a specificity of 44.1% and sensitivity of 80.0%. Conclusion More invasive stages of BC with greater progression potential are associated with an increase in enzymatic antioxidant activity and a decrease in non-enzymatic antioxidant capacity. It may suggest a possible role of antioxidants in the prediction and monitoring of illness trajectory.

Aim To investigate infl uence of neutrophil-to-lymphocyte ratio (NLR) and proatherogenic risk factors to improve the accuracy of pneumonia severity index (PSI) in the prediction of community acquired pneumonia (CAP) outcome in healthy individuals. Methods A retrospective observational cross-sectional study conducted at the Clinic for Pulmonary Diseases and Tuberculosis "Podhrastovi", University Clinical Centre Sarajevo, included 83 patients with the diagnosis of CAP during the period March 2019-March 2021. Once diagnosed with CAP, PSI score was calculated and according to its value the need for hospital treatment was identifi ed. Patients were divided in two groups: low risk of CAP (PSI <90), and high risk of CAP (PSI> 90). Results The overall average hospital stay was 22.76±10.154 days. In the patients diagnosed with CAP, a positive correlation was established between the following parameters PSI score and age (r=0.670; p<0.01), C-reactive protein-CRP (rho=0.287; p<0.01), leukocytes (rho=0.406; p<0.01), NLR (rho=0.313; p<0.01) and platelet to lymphocyte ratio (PLR) (0.296; p<0.05). CRP, leukocytes, NLR and PLR were statistically signifi cantly higher in patients with high risk of CAP compared to patients with low risk of CAP. Diastolic blood pressure, lymphocytes, eosinophils were signifi cantly lower in patients with high risk of CAP (p<0.05;) compared to patients with low risk of CAP (p<0.01). The optimal cut-off value of NLR for CAP patients was 3.089 with an estimated area under curve (AUC) of 0.664. Conclusion Proatherogenic parameters such as age, systolic blood pressure and leukocytes in combination with neutrophil-lymphocyte count ratio could improve accuracy of the pneumonia severity index in community acquired pneumonia outcome.

Background: Conflicting data exist on traditional lipid profiles in patients with Alzheimer’s disease (AD) and vascular dementia (VD), whereas scarce number of studies evaluated non-traditional lipid profiles in patients with AD and VD. Studies have shown that ethnic background may affect lipid profile. Objective: The aim of the present study was to conduct comparative assessment of traditional and non-traditional lipid profiles in Bosnian patients with AD and VD. Methods: A controlled, cross-sectional study was performed with 66 patients with AD, 50 patients with VD, and 60 control subjects. The Montreal Cognitive Assessment (MoCA) test was used for an evaluation of the global cognitive function. The Hachinski ischemic score was used to distinguish patients with VD from those with AD. Plasma total cholesterol (TC), high-density lipoprotein -cholesterol (HDL-C), and triglycerides (TG) levels were determined using standard enzymatic colorimetric techniques, whereas the Friedewald formula was used to calculate low-density lipoprotein-cholesterol (LDL-C) levels. The non-traditional lipid indices such as TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratio were separately calculated. The differences between the groups were analyzed with ANOVA followed by the Tuckey posthoc test or with the Kruskal Wallis test followed by the Mann-Whitney test. Results: Results of the present study have shown that patients in AD group had significantly lower level of TC, TG, LDL-C, VLDL-C, Non-HDL-C and significantly lower atherogenic index compared to the control group (CG) and compared to the VD patients. Significant difference in values of TG and VLDL-C was observed between VD and the CG, whereas no significant difference in values of TC, LDL-C, atherogenic index and Non-HDL-C was observed between these two groups. Our results have also shown that TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were significantly lower in AD patients compared to the VD and CG. Moreover, TG/HDL-C ratio was significantly lower in VD compared to the CG. However, a significant difference in TC/HDL-C and LDL-C/HDL-C was not observed between VD and the CG. Conclusion: Based on the results of the present study it can be deduced that there is a difference in traditional and non-traditional lipid profiles between AD and VD patients of Bosnian descent. Obtained results suggest that lipids are decreased in AD and in VD to a certain extent. However, since there is an inconsistence in literature whether there is an association between cholesterol and cognition, large prospective studies are required to elucidate this controversy.

Background: Lipids and lipoproteins are significantly involved in maintaining structural and functional components of the human brain and neurons, but their role in the development of Alzheimer’s disease (AD) and vascular dementia (VD) remains unclear. Objective: The aim of the present study was to explore the differences in the standard and novel lipid profile parameters in patients with AD and VD, stratified by the degree of cognitive impairment (CI). Methods: Present study included 66 patients with AD, 50 patients with VD, and 60 control subjects. For an evaluation of the global cognitive function the Montreal Cognitive Assessment (MoCA) test was used. In order to distinguish patients with VD from those with AD the Hachinski ischemic score was used. Plasma total cholesterol (TC), high-density lipoprotein -cholesterol (HDL-C), and triglycerides (TG) levels were determined using standard enzymatic colorimetric techniques, whereas the Friedewald formula was used to calculate low-density lipoprotein-cholesterol (LDL-C) levels. The non-traditional lipid indices such as TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratio were separately calculated. The differences between the groups were analyzed with the Kruskal Wallis test followed by the Mann-Whitney test or with ANOVA followed by the Tuckey posthoc test. Results: Results of the conducted study have found that the patients in AD group with moderate CI and patients in AD group with severe CI exhibited significantly lower levels of serum TC, TG, LDL-C, VLDL-C, Non- HDL-C, atherogenic index, TG/HDL-C, TC/HDL-C and LDL-C/HDL-C compared to cognitively normal control subjects. Moreover, patients in VD group with severe and moderate CI had significantly lower level of TG compared to control group of subjects. Our results have also shown that patients in AD group with moderate CI had significantly lower level of TC, TG, LDL-C, Non-HDL-C, atherogenic index, TG/HDL-C, TC/HDL-C compared to VD patients with moderate CI. In addition, patients in AD group with severe CI had significantly lower level of TC, LDL-C, Non-HDL-C and TC/HDL-C compared to VD patients with severe CI. Conclusion: The results of this study have shown dysregulation of lipid metabolism in AD and VD patients with different degree of CI. In both moderate and in severe CI, patients with AD had lower levels of majority of standard and novel lipid parameters compared to patients with VD. Further larger prospective studies are required to elucidate the accuracy of standard and novel lipid parameters in the assessment of different degree of CI in AD and VD.