Background: Hydrocephalus is the accumulation of cerebrospinal fluid in the ventricles of the brain. Ventriculoperitoneal shunt placement is one of the most commonly performed neurosurgical procedures and is necessary for the treatment of most forms of hydrocephalus. Objective: The aim of the study was to determine demographic indicators, comorbidities, complications and outcome of patients with hydrocephalus after ventriculoperitoneal shunt implantation. Methods: This is a retrospective study. Data on the subjects' age, gender, symptoms, degree of disability, complications, comorbidities and outcome after ventriculoperitoneal shunt implantation were recorded. All patients were clinically examined by neurologists and neurosurgeons and diagnosed through unified and standardized algorithms according to established guidelines for hydrocephalus. Cognitive functionality was assessed according to the Mini Mental State Test. Urinary incontinence was assessed based on patients' subjective feelings. Data on comorbidities and complications were collected from the patients' medical records. The degree of disability was assessed using the modified Rankin scale. Results: The average age of the subjects was 58.7 years, and the highest frequency of subjects was in the age group over 61 years (62.2%). There was no statistically significant difference in age in men (X=54.69, SD=18.77), or women (X=60.88, SD=19.96); t (35)=0.8, p=0.3. A statistically significant number of patients with hydrocephalus had a lower degree of disability after ventriculoperitoneal shunt implantation (p<0.05). Hypertension was the most common comorbidity with hydrocephalus (35.1%). Pneumonia was the most common general complication in patients with hydrocephalus (8.1%). Females had a statistically significantly worse survival (p=0.01). There was no statistically significant difference in the outcome of hydrocephalus patients in relation to age groups, comorbidities, general and complications after ventriculoperitoneal shunt implantation (p>0.05). Conclusion: Patients with hydrocephalus after ventriculoperitoneal shunt implantation have a lower degree of disability, and female patients have statistically significantly worse survival. Hypertension is the most common comorbidity, and pneumonia the most common complication in patients with hydrocephalus. There is no statistically significant difference in the outcome of hydrocephalus patients in relation to age groups, comorbidities, general and complications after ventriculoperitoneal shunt implantation.

Background: Stroke patients have significant disability and an increased risk of falling. Objective: To determine the incidence of falls and the degree of disability in stroke patients and to determine the correlation of falls with the degree of disability. Methods: This is a prospective study of 100 stroke patients confirmed by computed tomography and magnetic resonance imaging of the brain. We used a demographic questionnaire together with the Glasgow Coma Scale, Stroke Assessment Scale, Rankin Scale and Morse Scale to collect data and analyzed them using SPSS 17, including statistical measures, including Pearson correlation. Results: Hemorrhagic stroke patients had a higher incidence of falls (p = 0.06). There was no difference in the incidence of falls according to the gender of the patients (p = 0.07). Older people had a higher frequency of falls, and women and patients with hemorrhagic stroke had a higher risk of falling (p = 0.2). Patients with a stroke in the area of the anterior circulation were statistically significantly more disabled (p < 0.05). A weak positive correlation was calculated between the frequency of falls of patients after stroke and the degree of disability (r = 0.08, n = 94, p = 0.4). Stroke patients who also had atrial fibrillation as a comorbidity had a statistically significantly higher frequency of falls compared to patients with other comorbidities (p = 0.02). Conclusion: Patients with hemorrhagic stroke have a higher frequency of falls. Women, elderly people, patients with a stroke in the area of the anterior circulation and with atrial fibrillation as a comorbidity are statistically significantly more disabled after a stroke. There is a positive correlation between the frequency of falls in patients after a stroke and the degree of disability.

Background: Malnutrition is a frequent yet often overlooked comorbidity in patients undergoing surgery for colorectal cancer. It is associated with adverse postoperative outcomes, including increased complications, prolonged hospital stay, and elevated mortality. Objective: This study aimed to assess the clinical impact of short-term preoperative enteral nutrition in malnourished patients undergoing elective colorectal cancer surgery. Methods: A prospective cohort study was conducted involving 68 malnourished patients with histologically confirmed stage I–III colorectal cancer. Patients were divided into three groups: Group A (14-day enteral nutrition), Group B (7-day enteral nutrition), and Group C (no supplementation). Nutritional status, laboratory parameters, postoperative complications, transfusion needs, and hospitalization metrics were compared among groups. Results: Group A demonstrated the most favorable outcomes, including significantly fewer postoperative complications such as anastomotic leakage (5.0% vs. 17.9%, p = 0.030), reduced transfusion and albumin requirements, and shorter ICU and hospital stays (1.6 ± 0.7 and 7.1 ± 2.4 days, respectively). Group C showed the highest complication and mortality rates. Improvements in biochemical markers were observed in both intervention groups, supporting the efficacy of enteral supplementation. Conclusion: Short-term preoperative enteral nutrition significantly improves clinical outcomes in malnourished colorectal cancer patients undergoing elective surgery. These findings support the integration of nutritional screening and intervention as standard components of perioperative care in oncologic surgery.

Diabetes mellitus is one of the greatest public health challenges of the 21st century. The number of cases has been on the rise for many years, reaching a pandemic scale. The purpose of this study was to examine the risk factors relevant for the development of type 2 diabetes mellitus. The study was conducted at the Dorćol Primary Healthcare Facility within the Medigroup Healthcare system, with persons who had come in for preventive medical examinations over a period of six months. The study included 150 participants. Data on sex, age, arterial hypertension and pharmacotherapy were collected, and weight, height and glycaemia were measured. The Type 2 Diabetes Risk Assessment Questionnaire was used as the research instrument, in line with the recommendations of the National Guide for the Prevention of Type 2 Diabetes for primary care physicians (FINDRISC). The data were processed using IBM SPSS Statistics 22 (SPSS Inc., Chicago, IL, USA) software package. A higher risk for developing diabetes was observed in participants reporting irregular consumption of fruits and vegetables (38.0%), physical inactivity (34.0%), and in those with abdominal obesity (32.0%) and a positive family history of diabetes (17.3%). A timely intervention aimed at modifiable risk factors, primarily lifestyle interventions, can prevent type 2 diabetes and mitigate complications.

Background: The upper mini sternotomy Bentall (mini-Bentall) procedure may result in less trauma and earlier recovery compared with the usual full sternotomy Bentall procedure (Usual Bentall-DeBono procedure). Objective: This study evaluates the efficacy and safety of mini sternotomy aortic root surgery (MSARS), a minimally invasive technique designed to reduce surgical trauma, improve postoperative recovery, and lower healthcare costs. Methods: The upper mini sternotomy (UMS) approach was performed in ten patients focusing on standardized surgical procedures, and rigorous postoperative care. Key findings indicate that MSARS markedly reduces postoperative complications, ICU stay, and overall hospital stay compared to traditional sternotomy. Results: The median postoperative length of stay was seven days for MSARS versus 11 days for traditional sternotomy, with ICU stays of 27 hours and 105 hours, respectively. Our study also highlights the cost-effectiveness of MSARS, with decreased hospital costs per patient due to reduced ICU resource utilization and shorter hospital stays. These findings suggest that MSARS is a valuable and advantageous alternative to traditional sternotomy, offering substantial benefits in terms of patient outcomes and healthcare efficiency. Conclusion: Mini sternotomy aortic root surgery via partial upper sternotomy could be a safe alternative to the full median sternotomy, marking a significant advancement in the field of cardiac surgery.

The aim of this work was to rank and select the most favorable of six sweet cherry cultivars using the web-oriented FRUITrank application, which incorporates the MARCOS (the Measurement of Alternatives and Ranking according to Compromise Solution) multi-criteria decision-making algorithm. During the ranking, 10 criteria were taken into account, one of which relates to the harvest start time, three to the physical characteristics of the fruit (including the pedicel), four to the chemical properties of the fruit, and one to the organoleptic characteristics. Alternative A3 (Kordia cultivar) was ranked as the best, the Izabela cultivar (A4) as second place, while Summit (A5) was placed at the bottom of the ranking. Considering the fact that the complexity of algorithms of various MCDM (Multi-Criteria Decision Making) methods often limits their application, based on the results obtained, it can be concluded that the mentioned and similar digital solutions solve the mentioned problem, i.e., enable wider application of MCDM techniques both in fruit production and in agriculture in general.

The objective of this study was to provide decision-making assistance in selecting electric vehicles (EVs). The multi-criteria decision-making methods (MCDM), criteria importance through inter-criteria correlation (CRITIC) and evaluation by distance from ideal solution of alternatives (EDISA), along with the technical specifications of EVs, were employed to facilitate the decision on purchasing an EV. A total of 14 minivans were analysed based on 10 criteria. The findings from the CRITIC method indicated that the most significant criteria are battery charging and vehicle consumption. The EDISA method indicated that EV11 exhibited the best characteristics and represented a prudent purchase decision. Nevertheless, the ultimate decision must consider additional factors beyond just the technical specifications, as numerous elements affect the final choice, necessitating an examination of other attributes of the EV.

: With the increasing complexity of hotel selection, traditional decision-making models often struggle to account for uncertainty and interrelated criteria. Multi-criteria decision-making (MCDM) techniques, particularly those based on fuzzy logic, provide a robust framework for handling such challenges. This paper presents a novel approach to MCDM within the framework of Circular Intuitionistic Fuzzy Sets (C-IFS) by combining three distinct methodologies: Weighted Aggregated Sum Product Assessment (WASPAS), an Alternative Ranking Order Method Accounting for Two-Step Normalization (AROMAN), and the CRITIC method (Criteria Importance Through Inter-criteria Correlation). To address the dynamic nature of traveler preferences in hotel selection, the study employs a comprehensive set of criteria encompassing aspects such as location proximity, amenities, pricing, customer reviews, environmental impact, safety, booking flexibility, and cultural experiences. The CRITIC method is used to determine the importance of each criterion by assessing intercriteria correlations. AROMAN is employed for the systematic evaluation of alternatives, considering their additive relationships and providing a weighted assessment. WASPAS further analyzes the results obtained from AROMAN, incorporating both positive and negative aspects for a comprehensive evaluation. The integration of C-IFS enhances the model’s ability to manage uncertainty and imprecision in the decision-making process. Through a case study, we demonstrate the effectiveness of this integrated approach, offering decision-makers valuable insights for selecting the most suitable hotel option in alignment with the diverse preferences of contemporary travelers. This research contributes to the evolving field of decision science by showcasing the practical applicability of these methodologies within a C-IFS framework for complex decision scenarios.

Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary disease affecting small vessels in the brain caused by mutations in the NOTCH3 gene. It has a wide palette of clinical manifestations, usually starting with cognitive decline, migraine and headaches. Therefore, it is frequently misdiagnosed as a transitory ischaemic attack (TIA), ischaemic stroke, or migraine. As advances in genetic testing enable the detection of patients with CADASIL, its incidence is rising. However, CADASIL is still rarely diagnosed, especially in countries with scarce socio-economic resources in healthcare, such as genetic testing that is mandatory to diagnosticate CADASIL. However, it should be considered in everyday clinical practice as a differential diagnosis, especially in younger patients with positive family history. To our knowledge, there has not been a CADASIL case reported in Bosnia and Herzegovina. Objective: This case report aims to present rare confirmed case of CADASIL in a 56-year-old man that presented with rapid cognitive decline. Case presentation: A 56-year-old man was admitted to the Department of Neurology accompanied by his wife, who gave heteroanamnestic information. The patient works abroad and in the past month, during a telephone conversation, the wife noticed that the patient forgets what he has just said to her. The test results showed the presence of heterozygote mutation (c.401G>A) on the NOTCH3 gene, which confirmed the CADASIL diagnosis in this patient. He was further prescribed dual antiplatelet therapy and advised to do a follow-up exam in one month. Genetic advisory and testing of other family members was recommended, but it has not yet been conducted. He can still perform all activities of daily living. The importance of exome sequencing that enables the detection of a genetic mutations causing this rare disease is highlighted. Conclusion: Family members should also be advised to do genetic testing, as this enables the detection of CADASIL before the onset of symptoms. In addition, more aggressive preventive methods, life-style changes and symptomatic treatment can be included on-time, which will increase patient’s quality of life and decrease the development of various neurological complications.

Climate change is one of the main challenges facing the population around the world. The consequences of these changes have been manifested for decades in various ways, creating disasters that threaten the lives of an increasing number of people. This paper analyses the consequences of the floods that hit the United Arab Emirates on April 16, 2024. After any natural disaster, this flood also calls into question the approach, preparedness and response to this challenge, questioning the success of managing critical infrastructure. This is an important question given that in the last two decades the United Arab Emirates has encountered several floods of a more serious scale. In line with the further development of the consequences of climate change and in response to the challenges they bring with them when it comes to the United Arab Emirates, the authors also propose specific guidelines for the relevant institutions as a way of improving critical infrastructure. A significant area would be to focus on the latest technology in creating superior public-private partnerships that would become modern, national-integrated emergency management systems. The authors used the Risk Management Theory, suggesting ways in which preventive responses can be made. The authors also used content analysis, as well as the observation method.

Introduction: The mechanisms of pulmonary embolism in patients with metabolic syndrome has not been fully investigated. The aim of the study was to determine the connection between metabolic syndrome and pulmonary embolism and to evaluate the values of the glucolipid profile in patients with pulmonary embolism in metabolic syndrome. Methods: A cohort study included 305 patients with pulmonary embolism, divided into two groups: the first group with metabolic syndrome (n=165) and the control group without metabolic syndrome (n=140). The data was collected from May 2019 to May 2023. Demographic, anthropometric and laboratory parameters (glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) were analyzed in all patients with confirmed pulmonary embolism. Results: Patients with pulmonary embolism in metabolic syndrome had statistically significantly higher values of glucose, total cholesterol, LDL cholesterol, triglycerides and lower values of HDL cholesterol compared to patients with pulmonary embolism without metabolic syndrome (p<0.05). Discussion: The results of our research indicate a strong need for a broad evaluation of metabolic abnormalities with special highlight on comorbidities and the need for a multidisciplinary approach to patients with metabolic syndrome. Assessing the risk of pulmonary embolism should become imperative in the treatment of patients with metabolic syndrome. Conclusion: Metabolic syndrome may play a key role in the pathogenesis of pulmonary embolism and may be a link between venous thrombosis, atherosclerosis and pulmonary embolism. Due to the complex relationship between hyperglycemia, dyslipidemia and pulmonary embolism, additional research is necessary to answer the question why people with metabolic syndrome have a higher risk of pulmonary embolism, as well as to determine appropriate preventive strategies.

The growing need to reduce the negative impact on the environment and human health, as well as to meet the growing demand for eco-friendly textiles, has led to the development of environmentally friendly printing techniques and the use of natural dyes in the textile industry. Grape pomace is important waste material in winemaking, and has been extensively studied for its potential as a source of compounds with biological properties, especially anthocyanins, pigments responsible for the red, purple, and blue colors in grapes. The aim of this paper was to examine the potential use of natural dye extracted from grape pomace of domestic cultivar crna Mirisavka (GPCM) in preparation of printing paste with alginate, citric acid, and tannic acid for printing on cotton fabric. Special focus was placed to achieve process color magenta, by adjusting the pH value of the extract obtained. The natural dye from GPCM was extracted using maceration with 80% methanol, followed by sonication to enhance the yield of bioactive compounds. GPCM extract demonstrated significant antioxidant activity measured by FRAP, DPPH, and ABTS+ tests, and moderate antibacterial activity against Staphylococcus aureus and Escherichia coli. The pH-dependent stability of anthocyanins in GPCM extract was examined, demonstrating a magenta tone at acidic pH (pH 2-4) and color degradation at higher pH values. Cotton fabric printed with two different concentrations of GPCM extract (100 mg/L and 50 mg/L) showed good antioxidant and antibacterial activity. Based on the obtained results, it can be concluded that GPCM extract can be an environmentally friendly solution for the development of antibacterial and antioxidant textiles, with potential application in the production of protective clothing in healthcare institutions, as well as for the production of decorative home textiles, for the production of children's toys and textiles for packaging.