Aim To investigate outcomes of newborn hearing screening (NHS) with transient evoked otoacoustic emissions (TEOAE) depending on the time from the birth to hearing screening. Methods A prospective study was performed in the Cantonal Hospital Zenica, Bosnia and Herzegovina. The NHS with TEOAE was done before hospital discharge for all infants. The total of 1217 newborns were tested during a six-month period, from 1st February to 31st July 2016. The data of 1167 were available for analysis. Those data were divided in four groups depending on the time passed from the birth to hearing screening: Group A (n= 133 newborns, NHS performed in the first 24 hours after birth); group B (n = 294 newborns, NHS performed between 24-36h after birth); group C (n = 184 newborns, NHS performed between 36-48h after birth) and group D (n= 556 newborns, NHS performed later than 48h after birth). Results Total referral rate was 19.1% (n = 223): for group A 30.1% (n=40), for group B 25.2% (n=74), for group C 19.0% (n=35) and for group D 13.3% (n=74). There was statistically significant difference between groups A and C (p=0.03), between groups A and D (p<0.001) and between groups B and D (p<0.001) in total and in well baby nursery (WBN). Conclusion The total referral rates in NHS were high because of early post birth discharge of newborns. The NHS should be performed in infants older than 36 hours according to the results in this study.

In recent decades, the concept of forest certification under the Forest Stewardship Council (FSC) has been widely adopted in selected Southeast European countries (Bosnia and Herzegovina, Croatia, Serbia, and Slovenia). As sustainability is traditionally recognised as a leading principle in the forest management doctrine in these countries, the aim of this study was to understand whether, and how, FSC forest certification contributes to the sustainable management of state forests. The research was carried out in two phases. First, in order to assess forest management compliance with FSC standard, non-conformities for the period 2014–2018, identified in audit Public Summary Reports, were analysed in all public companies that managed state-owned forests in selected countries. Further, in-depth, semi-structured interviews with the professionals responsible for forest certification in these companies were conducted (n = 11) to determine the contribution of forest certification to the economic, ecological, and social aspects of sustainable forest management. In total, 185 non-conformities were analysed. The results showed that FSC certification was successful in addressing certain problems in forest management practices and contributed to sustainable forest management, mainly covering social and ecological issues. The most frequently identified non-conformities were those related to FSC Principle 4 Community relations and worker’s rights (32.3% of all non-conformities) and Principle 6 Environmental impact (30.4% of all non-conformities). The contribution of FSC certification to sustainable forest management is mainly reflected in the following aspects: Worker’s rights; health and safety of employees; availability of appropriate personal protective equipment; consultation with local people and interest groups; awareness of environmental impacts of forestry operations; waste disposal and storage of fuel; improving the image of forest companies and maintenance of high-conservation-value forests. The majority of non-conformities were minor and required procedural changes to be closed. Moreover, there are no statistically significant differences between the countries with regard to the number of non-conformities for all principles. It can be concluded that FSC certification, as a market-driven mechanism, plays an important role by influencing forest management practices and business operations of public forest companies in a positive manner.

Aim To describe a case of an eight-year-old boy with chronic Epstein-Barr virus (EBV) hepatitis with incipient cirrhosis, rarely found in practice. Methods The diagnosis was based on findings of specific IgG serum antibodies and EBV positive liver biopsy. Other etiologies of hepatitis were excluded: autoimmune hepatitis, viral hepatitis A, B, or C, cytomegalovirus (CMV), herpes simplex virus (HSV), adenovirus infection, toxoplasma infection. Results A mild form of infectious mononucleosis with acute hepatitis without icterus was found in the boy first time at the age of three. He got sick again in april 2018 with fever, minor loss of appetite and weakness, skin and sclera were anicteric, no enlarged neck lymph nodes. Ultrasonography of the spleen revealed a spleen diameter of 10.7 cm, while the liver was 11.8 cm. Laboratory findings, sedimentation, blood count, C reactive protein (CRP) were all normal. Ten days and a month later an increase of aminotransferase was noticed. The liver biopsy and PCR EBV DNA were performed six months of disease onset. The disease had lasted for about one more year with loss of strength and an increase of aminotransferase with maximum value of 3-4 times higher than normal one. The therapy was supportive. Conclusion Chronic EBV hepatitis is very rare. In differential diagnosis of hepatitis and unclear febrile conditions, EBV infection should not be forgotten.

Temperature distribution at depth is of key importance for characterizing the crust, defining its mechanical behavior and deformation. Temperature can be retrieved by heat flow measurements in boreholes that are sparse, shallow, and have limited reliability, especially in active and recently active areas. Laboratory data and thermodynamic modeling demonstrate that temperature exerts a strong control on the seismic properties of rocks, supporting the hypothesis that seismic data can be used to constrain the crustal thermal structure. We use Rayleigh wave dispersion curves and receiver functions, jointly inverted with a transdimensional Monte Carlo Markov Chain algorithm, to retrieve the VS and VP/VS within the crust in the Italian peninsula. The high values (>1.9) of VP/VS suggest the presence of filled‐fluid cracks in the middle and lower crust. Intracrustal discontinuities associated with large values of VP/VS are interpreted as the α−β quartz transition and used to estimate geothermal gradients. These are in agreement with the temperatures inferred from shear wave velocities and exhibit a behavior consistent with the known tectonic and geodynamic setting of the Italian peninsula. We argue that such methods, based on seismological observables, provide a viable alternative to heat flow measurements for inferring crustal thermal structure.

Aim To explore the experiences of anaesthesia nurses in assessing postoperative pain in patients undergoing total hip and/or knee arthroplasty. Methods Data were collected through four focus group interviews (FGI) using the critical incident technique (CIT). The participants were six men and 12 women, all registered nurses with further education in anaesthesia with at least five-year experience of caring for patients on a postoperative ward. Results Maintaining communication with orthopaedic patients, different ways to assess pain, the assessment of unresponsive patients, using pain assessment scales and different work circumstances influencing their use, were stated as the main problems the nurses emphasize while assessing the pain of patients. Conclusion Skills related to observing the behaviour and experience of pain in different individuals are needed to ensure an understanding of patients' pain, as well as the patients' ability to estimate their pain, where the intensity of the pain varies in different patients. Further studies are needed to examine the way health professionals assess pain, depending on the patients' ability to transform their pain from a subjective feeling into an objective numeric grade. The way individuals assess their pain differently and the way the resulting knowledge and experience of postoperative care may help nurses and other health-care professionals.

Aim To examine the effects of therapeutic hypothermia on the outcome of patients with the diagnosis of out-of-hospital cardiac arrest (OHCA). Methods The study included 76 patients who were hospitalised at the Medical Intensive Care Unit (MICU) of the Clinical Centre University of Sarajevo, with the diagnosis of out-of-hospital cardiac arrest, following the return of spontaneous circulation. Therapeutic hypothermia was performed with an average temperature of 33oC (32.3 - 34.1o C) on the patients who had coma, according to the Glasgow Coma Scale (GCS). Results Multiple organ dysfunction syndrome (MODS) significantly affected survival (p=0.0001), as its presence reduced patients' survival by 96%. In addition, ventricular fibrillation (VF) as the presenting rhythm, also significantly affected survival (p=0.019). A degree of patient's coma, as measured by the GCS, significantly affected survival (p=0.011). For each increasing point on the GCS, the chance for survival increased twice. Moreover, other physiological factors such as the pH and the lactate serum levels significantly affected patients' survival (p=0.012 and p=0.01, respectively). Conclusion In patients with the diagnosis of OHCA who underwent to the treatment with therapeutic hypothermia, verified VF as a presenting rhythm was a positive predictive factor for their outcome. Therefore, therapeutic hypothermia represents an option of therapeutic modality for this type of patients.

Introduction: Knowledge of the size of surfaces available for transport is important for assessing the amount of nutrients that can be transmitted to the fetus for its normal growth and development. Aim: The aim of our study, was to determine the stereological structural parameters of the parenchymal part of placenta, ratio of birth weight and placental weight, and to determine their correlation with the body length and head circumference of the newborns of adolescent pregnant women. Methods: The study was conducted on a total of 60 human placentas of term pregnancy, divided into two groups according to the age of pregnant women. The experimental group consisted of 30 placenta of pregnant women aged 13-19. The control group consisted of 30 placenta of pregnant women aged 20-35. Computer assisted morphological analysis of images of histological preparations using stereological methods was performed. Results: Surface density of terminal villi of adolescent placentas is significant higher than the control group (t = 14,179, df = 29, p <0,0001). The T-test (t = -5,868, df = 29, p <0,0001) showed statistically significant difference in the surface density of fibrinoid in two compared groups. T-test (t = 6.438, df = 29, p <0.0001) found that total surface of terminal villi was significantly higher in adolescent placentas. The T-test (t = -6,747, df = 29, p <0,0001) found that total surface of fibrinoid was significantly lower in adolescent group. The T-test (t = 4.203, df = 29, p <0.0001) found that the ratio of birth weight of newborn and adolescent placental weight was significantly higher in relation to the control group. Conclusion: Adolescent placentas was more efficient in increasing the weight of newborns, compared to the control group placentas.

Aim To examine the relationship of protective factors (self-esteem, optimism, proactive coping), and a measure of psychological resistance in women diagnosed with breast cancer, and the contribution of protective factors in explaining the criterion of posttraumatic growth. Methods The study included 100 women diagnosed with breast cancer. To examine optimism the Scale of Dispositional Optimism and Pessimism, the Scale of Self-esteem for self-esteem and the Scale of Proactive Coping for proactive coping were used. The posttraumatic growth measured five factors: relating to others, new possibilities, personal strength, spiritual changes, appreciation of life. Results Self-esteem, optimism and proactive coping were associated with posttraumatic growth and its factors: new possibilities, personal strength, appreciation of life. Optimism and proactive coping positively corelated also with relating to others. Final model of posttraumatic growth in all three steps (self-esteem, optimism, proactive coping) explained 20.4% variability of the posttraumatic growth total score. Conclusion Posttraumatic growth does not mean a decrease in trauma, but leads to a change in the perception and view of life. It refers to more favourable management and use of its own resources, relying on its own strengths and capabilities, identifying new opportunities and connecting with others.

Aim To compare intraoperative hemodynamic and respiratory stability and postoperative emergence delirium between two anaesthesia regimens in children (caudal block with intravenous continuous analgosedation versus general endotracheal anaesthesia) and intensity of postoperative pain and quality of postoperative analgesia. Method Forty children aged 2-6 years who underwent lower abdominal surgery were randomized depending on performed anaesthesia into two groups: caudal block with analgosedation (group CB) and general endotracheal anaesthesia (group GA). Intraoperative hemodynamic and respiratory stability were evaluated measuring systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR) and arterial oxygen saturation (SaO2) in preinduction (t0), at the moment of surgical incision (t1), 10 minutes after surgical incision (t2) and at the time of skin suturing (t3). Postoperative emergence delirium was evaluated using Paediatric Anaesthesia Emergence Delirium score (PAED). Postoperative pain was evaluated by Children's and Infants' Postoperative Pain score (CHIPPS). Both scores were recorded every 5 minutes during first half hour postoperatively, additionally after 60 minutes postoperatively for CHIPPS score. Results SBP, DBP and MAP were lower at t1 (p<0.0001), t2 (p<0.05) and t3 (p<0.001) in the group CB. HR was lower at all studied time points (p<0.005) in the group CB. SaO2 was lower in the CB group but comparable with the GA group. PAED and CHIPPS scores were lower at 5, 10, 15, 20 and 25 minutes postoperatively (p<0.001) in the CB group. Conclusion Caudal block with analgosedation provides better control of intraoperative hemodynamic conditions, postoperative emergence delirium and postoperative pain than general endotracheal anaesthesia.

OBJECTIVES In silico bioinformatical analysis suggested that the expression of two genes, CCL5 (C-C Motif Chemokine Receptor 5) and ep300 (Histone acetyltransferase p300), could be used as potential new biomarkers in differentiation between periapical granulomas and radicular cysts. Thus, we hypothesized that gene expression of CCL5 and ep300 in periapical lesions would classify the lesions as either granuloma or cyst. MATERIALS Patient samples (n=122) included 46 periapical granulomas, 38 radicular cysts and 38 healthy gingival samples as controls. Real-time PCR analysis of CCL5 and ep300 transcripts was compared to SDHA (Succinate dehydrogenase complex, subunit A) as the reference. Clinical parameters (e.g., intensity of inflammation and lesion size) were measured and correlated with CCL5 and ep300 expression. ROC (Receiver operating characteristic) and logistic regression analyses were used to establish the diagnostic character of ΔCt values. RESULTS Granulomas and radicular cysts had significantly higher expression of CCL5 and ep300 compared to controls (P<0.05). However, no differences were observed when comparing granulomas and radicular cysts. ROC analyses showed that CCL5 and ep300 have good diagnostic accuracy, but low accuracy for distinguishing between the lesions. CONCLUSIONS This study confirmed that expression of CCL5 and ep300 is relevant for the pathogenesis of periapical inflammatory lesions but cannot be used as a distinctive marker between these lesions.

OBJECTIVE Lysozyme is a natural antimicrobial and immunomodulatory enzyme, which is produced as a host response to infectious agents. The objective of this study was to compare the efficacy and safety of lysozyme-based versus benzydamine and chlorhexidinebased oral spray in patients with an acute tonsillopharyngitis associated with a common cold. PATIENTS AND METHODS A prospective twoarm pilot study (lysozyme/cetylpyridinium/lidocaine spray versus: benzydamine spray-arm 1; chlorhexidine/lidocaine spray-arm 2) was conducted in the primary health care unit. Efficacy was evaluated by the patient's self-assessment of pain, difficulty in swallowing and the throat swelling, by using the visual analog scale (VAS) at baseline and three follow-up visits. Safety was evaluated by the assessment of the frequency and severity of adverse effects. RESULTS Lysozyme-based spray reduced pain faster than benzydamine-based spray and slower than chlorhexidine-based spray. Lysozyme-based and chlorhexidinebased sprays similarly reduced difficulty in swallowing, but were faster than benzydamine-based spray. Similar effects on the reduction of throat swelling were seen in all treated groups. All tested products showed proper safety and were well tolerated, with no serious adverse events reported. CONCLUSIONS The lysozyme-based oral spray was shown to be effective and safe in the reduction of pain, difficulty in swallowing and throat swelling in patients with acute tonsillopharyngitis associated with a common cold. Lysozyme-based oral spray (containing natural compound with advantages of influencing immune system and preventing recurrences) had similar activity to benzydamine and chlorhexidine-based oral antiseptic sprays.

Introduction: Acute kidney injury (AKI) is one of the major public health issues with constantly increasing incidence, with epidemiology and outcomes that vary substantially across the world. Aim: Aim of our study was to determine epidemiological characteristics and causes of AKI and to provide a comparison of our findings with data from other low and middle income countries. Methods: This retrospective observational study conducted during an 18-month period included 84 patients. Data were collected from hospital information system and patients’ medical records. All data were analyzed using descriptive statistics. Results: More than two-thirds of patients were older than 56 years. Most cases of AKI (54,76%) were hospital-acquired and predominantly developed in intensive care units (32,14%). Dominant risk factor was underlying chronic kidney disease (48,81%) and chronic heart failure (45,24. In majority of patients (73,81%) were identified multiple factors that may have contributed to AKI: infection (90,48%), prerenal factors (77,38%), nephrotoxic agents (69,05%), and sepsis (28,57%). Multiple organ failure was identified in 94,05% of patients: cardiovascular (64,56%), respiratory (58,23%) and hematological (56,96%) system. Half of all patients were alive at last observation day. Leading cause of death was infection/sepsis (21,43%), followed by cancer (16,67%) and shock (14,28%). Conclusion: Data on AKI show great variation, but general picture of AKI resembles more that from high income countries. The need for dialysis and overall mortality remains high. This highlights the importance of early recognition of AKI, timely referral to nephrologist and need for national guidelines and standardized protocols for AKI.