OBJECTIVES Cone beam computed tomography (CBCT) in dentistry and maxillofacial surgery is a widely used imaging method for the assessment of various maxillofacial and dental pathological conditions. The objective of this study was to summarize the results of a multinational retrospective-prospective study that focused on patient exposure in this modality. METHODS The study included 27 CBCT units and 325 adult and paediatric patients, in total. Data on patients, clinical indications, technical parameters of exposure, patient dose indicator, or, alternatively, dose to phantom were collected. The dose indicator used was air kerma-area product, PKA. RESULTS In most scanners operators are offered with a variety of options regarding technical parameters, especially the field-of-view (FOV) size. The median and the third quartile value of PKA for adult patients in 14 different facilities were 820 mGy cm² and 1000 mGy cm² (interquartile range, IQR = 1058 mGy cm²), and 653 mGy cm² and 740 mGy cm² (IQR = 1,179 mGy cm²) for children, as reported by four different institutions. Phantom dose data were reported from 15 institutions, and median PKA ranged from 125 mGy cm² to 1951 mGy cm². Median PKA values varied by more than a tenfold between institutions, mainly due to differences in imaging protocol used, in particular FOV and tube current-exposure time product. CONCLUSIONS The results emphasize the need for a cautious approach to using dental CBCT. Imaging only when the clinical indications are clear, accompanied with the appropriate radiographic techniques and the optimum imaging protocol, will help reduce radiation dose to patients.

Geiges Andreas1, Paola Yanguas Parra1, Marina Andrijevic1,2, William Hare1, Alexander Nauels1, Peter Pfleiderer1,2,3, Michiel Schaeffer1,4, and Carl-Friedrich Schleussner1,2,3 1Climate Analytics, 10961 Berlin, Germany 2IRITHESys, Humboldt University, 10117 Berlin, Germany 3Potsdam Institute for Climate Impact Research, 14473 Potsdam, Germany 4Department of Environmental Sciences, Wageningen University and Research Centre, 6700 AA Wageningen, The Netherlands

Fault passage indicators (FPIs) and fault locators (FLs) are employed in modern distribution networks in order to enhance the process of fault localization, thus resulting in reduction of interruption time and improving the reliability of power supply. In this paper, a novel probabilistic techno-economic optimization method is proposed for determining the number and positions of FPIs that lead to maximum reduction of interruptiontime and investment costs in medium voltage (MV) distribution networks with and without FLs. The proposed method is basedon a probabilistic non-sequential Monte Carlo simulation model of the real network, which is a proper compromise between complicated sequential simulation models and too simplified analytical models. The main goal of the method is to obtain maximum improvement of the network reliability indices while using the minimum number of FPIs. The method is tested on a combinedurban/rural MV distribution network in Bosnia and Herzegovina and results are thoroughly discussed.

The aim of this review is to discuss the local experience of Tuzla’s hospital staff and the knowledge needed to become a Baby-Friendly Hospital (BFH). We also discuss the risks of formula feeding. While breast milk is the natural modality of infant feeding, in Tuzla Canton, the rate of exclusive breastfeeding in the first 6 months of life is only 12%. During the war of 1992-1995, which was the worst European atrocity since World War II and the worst set of events in the recent history of Bosnia-Herzegovina, we had the opportunity to learn more about the impact of breastfeeding on child health from Chloe Fisher, a renowned clinical specialist on infant feeding. The United Nation Children’s Fund (UNICEF) and the World Health Organisation (WHO) held several seminars, about recommended practices and procedures needed to become a BFH. As a result, the Maternity Hospital was certified as a BFH in 2004 and has been operating with this status since then. While our Maternity Hospital and other related departments provided services and care of infants, many infant formula companies donated milk and organized conferences and other paediatric events to promote infant formula. This and other obstacles resulted in the fact that currently only 3 out of 7 mothers in our neonatology department breastfeed, and only 1 baby out of 7 is exclusively breastfed. Conclusion – Transforming a hospital in Baby-Friendly means, amongst other things, all professionals must provide breastfeeding management to ensure a long-term breastfeeding policy. The current low breastfeeding rate in our hospitals is the result of inconsistent policies in achieving long-term goals in breastfeeding practices.

Objective − To present a rare case of osteoid osteoma of the metacarpal bone and to emphasize the importance of correlation of radiological analysis with anamnestic data and clinical findings. Case Report − We reported the case of osteoid osteoma of the metacarpal bone in a 14-year old girl. The patient, a volleyball player, presented with pain in the left hand. At first, nonsteroidal anti-inflammatory drugs relieved the pain but over the time it became more intense and was accompanied with swelling. On the basis of magnetic resonance imaging (MRI), the case was misdiagnosed as a status post-fracture of three metacarpal bones. After inappropriate treatment with physical therapy, the patient’s condition worsened, thus multiple laboratory tests and radiology imaging techniques were performed to achieve the right diagnosis. Diagnosis of osteoid osteoma was finally made by CTscan and appropriate treatment by surgical ablation was performed. Conclusion − Osteoid osteoma rarely occurs in metacarpal bones. Physicians should be aware of the atypical clinical presentation of this benign lesion in the metacarpal bones.

The paper deals with selected examples of clock towers in Bosnia and Herzegovina, representing high masonry heritage buildings made of stone, and explains the approach used in their preservation and restoration. The aim of this paper is to present a specific method of conservation used on stone structures. Three clock towers from Bosnia and Herzegovina were selected as representative examples: Sarajevo Clock Tower from the 16th century is an example of well-preserved building; The Clock Tower in Gradačac, the youngest building of this type in Bosnia and Herzegovina, is in poor structural conditions and in danger of collapsing; The Clock Tower in Banja Luka, the first clock tower in Bosnia and Herzegovina, was demolished in 1993 but the reconstruction project is planned for the current year. This paper addresses the structural properties of masonry clock tower from the Ottoman period, with special attention to preservation, analysis and strengthening. These tasks are still a challenge for masonry practitioners even if significant advances in research have been made in the last decades. The dynamic behavior of the historical buildings is usually analyzed to design repair intervention solutions and retrofitting. The structural behavior is analyzed using FEM modeling to examine how far the structural defects endanger the stability of the tower. The soil properties problem under the tower has been considered. Simplified yet effective procedures have been used as well. Results of the analysis have confirmed insufficient performance of the structure under horizontal action and the need for improvement.

Life cycle assessment (LCA) is defined as decision making method for buildings from “cradle to grave”. Considering the fact that the construction industry produces 38% of total waste and 40% of total CO2 emissions and uses 50% of all natural resources, according to EIB 2015, the building industry has to change this way of thinking to the concept “cradle to cradle”. According to European Commission (Directive 2008/98/EC 2008), the first and preferred option is waste prevention and the second option are other types of recovery. The waste should be prevented in the design phase and LCA should help a lot in this stage. The main goal of this paper is to show how the LCA can be used as a tool in design phase to help decision process in building design of one of the building systems and make that part circular and, if possible, without waste. External wall, as one of the systems of a building, is taken as case study in its different materialization to show LCA use in the construction waste elimination in building practice. The external wall is the system of a building which is the most exposed to external factors, as weather conditions and human. Very often, the wall is damaged before other systems of a building. Hence the design and building of external walls that produce less waste, is a huge step in construction waste management. The LCA software is used to compare two chosen case studies. The first one is prefabricated wooden wall for low energy houses. The second one is the wooden wall made for Green Design Centre in Mostar in 2018. The first results show that in the second case study, the wall made for reversible and transformable building, and designed according to circular building principles, has better chances to last longer, and produce less waste during its transformations and aging. The paper shows main principles for designing the low waste wooden walls and also some remarks how to upgrade the software to be more helpful in the design phase of the wall systems.

Nowadays, masonry heritage buildings usually experience changes during exploitation. In areas of emphasized seismic risk, in cases of extensions, alterations to the original dimensions, reconstruction (the removal of bearing elements, replacement of materials, introduction of new fittings), or the subsequent erection of properties close by, with a comparison of the foundation levels change of use, refurbishment, extension, or additional building to an existing building. It is necessary to analyze the seismic aspect of such interventions in seismic prone areas. At first, we’ll focus on the legal and technical regulations. For start we’ll look back at UNESCO’s Program on Masonry Heritage, then domestic and regional legal and technical regulations and with all of that we will define the first step of the process. Next step would be a detailed registration of the current condition of the building, and also determining the characteristics of the embedded materials. The load bearing structures of the building must also be accurately identified, with all relevant measurements and, in particular, a description of the building materials and their condition. This includes all detailed maps, plans, and details of the used materials, and especially detailed record of all the damages on the structure. Even at this early stage of investigative works it may prove necessary to secure certain structural elements, or even the entire building, to prevent it from collapsing. As a rule, this requires not only the removal of the outer cladding or even of parts of a wall to determine the depth of cracks but also, if there is any suggestion of subsidence, excavations around the building or to the depth of the foundations. Calculations, based on the planned and current condition of the building, will show whether the strengthening and rehabilitation are needed for the structure. The elements that need reinforcement or conservation can be identified during the initial visit, and provision can immediately be made to take the necessary steps to relieve the load. It is necessary to do all the steps regarding technical regulations, legal regulations, methods of approach, theoretical consideration, methods of calculation, and in the end to determine the needs of that building. Theoretical consideration regarding the determined condition of structure, from all the above aspects, is the next step to be done. This also includes evaluation of the viability of these interventions, based on experience. The most sensitive issue, without doubt, is determining the condition of the foundations. This should be addressed with the utmost care with the general opinion of the building’s stability in mind.

Building envelope has significant role in the building sector. It represents immediate interaction between outside and inside environment. In dependence of its characteristics and opposed requirements, it affects on achievement of the thermal comfort of inside area and closer environment. Existing standards in the building sector dictate air tightness of an envelope, limiting air infiltration with the aim to save energy, but also influence on the inside environmental quality in situation when optimal air quality cannot be achieved due to the insufficient ventilation of the room. Besides that, building envelope in dependence of its characteristics, under the influence of Sun light, can less or better absorb heat flux and cause the temperature rise on the surface of the building. Specific characteristic of material to absorb and retain solar thermal heat, in urban environments, contributes more and more to the presence of the phenomenon known as urban heat island. For interaction of the building envelope with the environment factors, the building of Mechanical Engineering Faculty was chosen as a case study, on which the measurement of the envelope surface temperature was performed with the aim to empirically confirm presence of higher temperatures on building envelope. At the same time, the measurement of indoor air quality parameters, as carbon dioxide concentration, inside air temperature and relative humidity was performed, to estimate ventilation efficiency of inside area. Results of the measurement have shown the presence of relatively high surface temperature on the building envelope, which is the in accordance with the earlier research about the existence of higher surface temperatures in dependence of its characteristics and environment. Measurement of indoor air quality parameters showed higher carbon dioxide concentrations, especially in winter semester, which values exceeded by 60 % of recommended ones. Higher carbon dioxide concentrations are result of insufficient ventilation of the room, and it is indicator that optimal cooling system with frequent ventilation is necessary criteria that needs to be fulfilled to achieve quality inside environment from the aspect of the comfort, productivity and health of users. In the recent years, there has been noticed evident increase of the outside temperature, especially in urban area due to the construction and characteristics of applied materials in buildings, resulting also in the climate change. It is necessary to emphasize that planners and designers in the conceptual stage of construction or renovation of the buildings, incorporate solutions and decisions about the materialization of the envelope, which will affect on the reduction of urban heat island, considering as one of the energy efficiency measures.

ABSTRACT Background: Towards preparation for a possible influenza pandemic, investigation of the molecular characteristics of the circulating avian H5N1 influenza virus strains is of crucial importance. These H5N1 viruses continue to spread, to infect animals and humans and to evolve and diversify providing so an ever-looming pandemic threat.Aim: To identify genetic structure and molecular biological characteristics of BiH's isolates of H5N1 HPAI as well as to assess the level of pathogenicity, phylogenetic origin and host- specificity of the isolates.Material and Methods: SPF embryonated chicken eggs were used for virus isolation. Viral RNA extracted using QIAamp viral RNA kit and manufacturer’s protocol (QIAGEN®) was used for PCR amplification. cDNA synthesis and PCR amplification of the coding region, using gene specific primer sets (primer sequences available on request), were carried out for all eight viral RNA segments separately. The Prism Big Dye Terminator v1.1 cycle sequencing kit (Applied Biosystems) was used and products were analyzed on an automatic ABI PRISM 3130 genetic analyzer (Applied Biosystems). Nucleotide sequences were analyzed using Bioedit software (v. 7.0.9.0) with an engine based on the ClustalW 1.4 algorithm. MEGA software (v. 4,0), using the neighbor joining tree inference analysis with the Tamura-Nei γ-model, was used to estimate phylogenies and calculate bootstrap values from the nucleotide sequences.Results: Full-length nucleotide sequences of the A/Cygnus olor/BIH/1/2006 (H5N1) strain were deposited in EMBL Nucleotide Sequence Database under accession nos. FN186008 to FN186014 and FM20943. The pathogenicity and host specificity of this strain, as polygenic traits, are determined in silico by the structure of its proteins, especially surface glycoproteins, HA and NA. Multibasic amino acid stretch PQGERRRKKR/GLF, marker of strains highly pathogenic to poultry, was present at the HA cleavage site of BiH strain. The RBS was typical for avian influenza viruses and contained Gln and Gly at positions 238 and 240 (H5 numbering) that is,226 and 228 according to H3 numbering with seven potential glycosylated sites but with increased binding to alpha2-6 sialoglycans thanks to substitutions, as follows, 110N, 171N, 171N, 172A, 205R and 251P. NA structure assigned this strain to the Z genotype, characterized also by the deletion of the five amino acid residues of the NS1 protein (positions 80-84). Amino acid residues, typical for the avian influenza viruses, were revealed in 40 out of 43 positions of M1, M2, NP, PA, PB2 and HA, determining the host range specificity. Phylogenetic analysis of the HA gene revealed that BiH isolates belonged to genetic clade 2.2., and presence of aspartic acid at the position of 403 of HA locate BiH isolates in 2.2.2. sub-clade.Conclusions: The BiH’s isolates were determined as HPAI virus with genes sequences closely related to A/Cygnus olor/Astrakhan/Ast05-2-10/2005 (H5N1). Three residues (M2 - 28V and 78K, NP - 33I), typical of human influenza viruses, were found, indicating a certain degree of intercurrent evolutionary adaptive changes in BiH isolates. Sequence comparison of HA and NA segments with relevant sequences in GenBank revealed that the BiH isolates and the ones from the southern Russia (Astrakhan region) group together phylogenetically, forming a monophyleticcluster in both genes indicating that these isolates have evolved from the same origin. Sequence derived phenotype markers of NA protein (E99, V129, D131, R136, H255 and Y256) as well as of M2 protein (26L, 27V, 30A, S31 and G34) showed that the isolates have an oseltamivir and amantadine sensitive genotype. 

Background: Colonization is the presence of bacteria in the intestines, skin, nose, throat or anywhere in the human body without any signs of infection but with increased risk for spreading bacteria to other patients and the emergence of new infections. Screening of colonized patients is used as part of the prevention and control of multidrug-resistant (MDR) infections caused by agents such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and multi-resistant Gram-negative bacteria. Material and methods: Data from 169 screened respondents hospitalized at the University Clinical Center Tuzla, between October 1, 2018, and May 1, 2019, were analyzed. Swabs were taken from nostrils, throat, axilla and groin area for all patients, and also from the anorectal area for 157 of them. Identification of MDR bacteria was done by phenotypical methods, according to the recommendations of EUCAST Clinical Breakpoint Table v.8.0, 2018. Results: Out of 169 patients, negative screening test results were found in 93 examinees (55.02%), and positive in 76 (44.97%). The largest number of patients undergoing screening was hospitalized in the Intensive Care Unit (Surgical Block), 73/169 (43.19%). The average screening time was 2.2 days or 53 hours. In 18/76 (23.68%) of patients with positive screening, prior to screening regular microbiological testing was done, and in the remaining 58/76 (76.3%) screening was performed first. Analyzing respondents with positive screening, 27 (35.53%) had negative findings during regular microbiological testing of different biological samples and for 49 (64.47%) different/same strains of MDR bacteria were isolated.Conclusion: Knowing the phenotypic profile of bacteria colonizing patients in intensive care units is a very useful tool in preventing their spread intra- and inter-hospitals.

Introduction: Inflammatory fibroblast tumor is rare tumor that most often occurs in younger people, usually 30 years old or younger, but most commonly in children age 6-10 years. It usually affects gastrointestinal tract and the lungs but it can also occur in several places at the same time. Clinical manifestations vary depending of the affected system of the body so it is very difficult to determine diagnosis without surgical extirpation and patohistological analysis. Complete surgical resection is curative in most patients and recidivism is rare. Liver abscesses more common occur in females with risk factors and medical history of diabetes, previous liver disease and less likely in patients with granulomatous diseases. Liver abscesses mortality in developing countries is 2-12%, increasing due to open surgical drainage.Case report: We present a 35 years-old patient who was treated at the Clinic for Infectious Diseases University Hospital Mostar and University Hospital Sarajevo, Clinic for Infectious Diseases in August and September 2018 and Clinical Hospital Merkur, Zagreb Surgery Clinic in December 2018. Data was used from medical documentation. Young, immunocompetent patient who was addmited to a hospital following high fever, chills and poor general condition was diagnosed with multiple focal necrotic lesions, differential-diagnostically most likely liver and spleen abscesses with high suspicion of liver malignancy. Liver biopsy was performed and patohistological analysis confirmed the diagnosis of multiple liver abscesses in the IV and VI liver segment, and inflamatory fibroblast tumor in the IV liver segment. Eight weeks of conservative treatment resulted in a complete regression of liver abscesses and inflamatory fibroblast tumor was surgically extirpated at the Clinic Hospital Merkur, Surgery Clinic in the Zagreb in December 2018.Conclusion: An approach to a patient with a multiple liver abscesses and liver tumor requires sub-specialists experience and urgent multidisciplinary diagnostic and treatment approach to prevent further complications and deadly outcome.