Objectives: Increased C. difficile infection rates were observed during the last decade, as well as the onset of complicated forms of the disease. The primary objective of this study was to report the first outbreak of C. difficile in a Serbian hospital, aiming to determine clinical and environmental factors associated with the outbreak. The secondary objective was to describe outbreak control measures taken.Design: The retrospective cohort study conducted from 18 April to 22 May 2013 in Serbian healthcare. Ninety-five patients hospitalized at the Department for orthopedic surgery during the CDI outbreak.Results: Prophylactic antibiotic therapy was identified among 93.3% patients with and 87.9% without C. difficile infection. The multivariate logistic regression analysis has shown that the independent risk factors for C. difficile infection incidence are the age beyond 70 (OR = 4.5; 95%CI = 1.1-18.2; p = .031) and the length of antibiotic therapy (OR = 1.5; 95%CI = 1.1-2.1; p = .017).Conclusion: The length of antibiotic prophylaxis is linked with the incidence. Orthopedic departments have a risk of C. difficileinfection. Infection control measure, antimicrobial stewardship programs and compliance to guidelines for the prescribing of antibiotics play important role in the prevention of C. difficile infection burden.

With the ever increasing cell densities in wireless networks, it is desired to enable more self-X features, such as self-configuration. Setting the network parameters in an autonomous manner is not only more time efficient but also increases network performance and reduces the probability of a human error. Among numerous network settings, one of the key parameters that requires such autonomous configuration is the cell ID (CID). It is used during fundamental procedures, such as network access, decoding, or handover, and therefore, its configuration is crucial for network operation. A complete CID management framework together with a centralized method for CID assignment is presented in this paper. It is not only applicable to multiple mobile standards but is also compatible with multi-vendor equipment, since it is based on the TR-069 management protocol. The proposed approach mitigates CID conflicts when there is a high level of reuse. Moreover, in the 4G case it also prevents neighbors from using different CID but with the same reference signal pattern, which avoids significant interference. The proposed method is evaluated in an enterprise small cell scenario, and in comparison with the baseline third generation partnership project approach, significant reductions of assignment conflicts are demonstrated.

Thermal changes in water cause many metabolic changes that manifest themselves in physiological fish adaptations. The analysis of hematologic and biochemical blood parameters provides important information on environmental influences on the health status of fish. The hematocrit (HCT) (l/l), hemoglobin concentration (Hb) (g/l), mean corpuscular volume (MCV) (fl), mean corpuscular hemoglobin (MCH) (pg), mean corpuscular hemoglobin concentration (MCHC) (g/l) and red blood cells (RBC) (x1012/L) were analyzed. Animals were grouped into two groups: control (n=10) and experimental (n=16). The experimental fish were exposed to 28°C for 30 min. Puncture of the heart was done and the blood without anticoagulant was analyzed. During hyperthermia, an increase in hematological parameters was observed, except for MCV values that were low. Significant differences were established only for the number of erythrocytes and the hematocrit values (p<0.05). The results showed a decrease in MCV and an increase in the value of other erythrocyte parameters. Significant changes in the number of erythrocyte and hematocrit values were found. Some hematological parameters such as erythrocyte and MCV values are significant stress indicators and can serve us as important factors for physiological adaptations of fish. The carp shows excellent ability to adjust to temperature variations that can be seen through the analysis of hematological status.

The objective of this study was to investigate causal associations between cattle farms’ management practices and reproductive disorders (abortion, stillbirth, retention of placenta, metritis). Besides, direct causal associations between farms’ management and reproductive infections (Chlamydia abortus, Coxiella burnetii, and Neospora caninum), reproductive disorders and infections were also investigated in this study. As a secondary objective, constraints that affect the production in cattle farms were examined. The study was carried out in the north-western (Una-Sana), western (Canton 10) and central part (Central Bosnia Canton) of Bosnia and Herzegovina. A total of 201 farms were selected for participation. A semi-structured questionnaire-based interview was conducted among farmers/managers from January 1st to August 31st, 2015. The 40 questions were divided into three groups: socio-demographic, management, and information on reproductive performances in cattle. Supplementary questions were asked about the perceived primary constraints of the production. A multivariable mixed-effects logistic regression was used to screen management factors for potential statistical influence. All investigated outcomes were associated with farms’ management. The final multivariable models were merged into a Structural Equation Model (SEM). The causal model was then specified graphically. The SEM model showed that herds that experienced abortions (OR=4.3) and stillbirth (OR=6.7) were associated with N. caninum seropositivity. Also, herds that experienced retention of placenta were strongly associated with the occurrence of metritis (OR=10.1). C. abortus and C. burnetii herd seropositivities were mainly associated with environmental factors and contact with potential intermediate hosts. Our study demonstrated that management practices on dairy farms in Bosnia and Herzegovina contributed to the occurrence of severe reproductive outcomes and reproductive infections. N. caninum seems to be an infectious agent that substantially contributed to the reproductive underperformance. Further we demonstrate the need for using causal models in understanding complex relationships.

Of the four species of the genus Satureja (Lamiaceae) that are recognized in Bosnia and Herzegovina, S. subspicata has the the widest distribution. It is taxonomically challenging species of geographically limited distribution and little data on its genetic diversity throughout its range is available. We sampled six geographically distinct populations from Bosnia and Herzegovina and applied nrDNA (ITS1, ITS2), chloroplast markers (matK and trnL) and AFLP to examine genetic diversity of S. subspicata in the center of its distribution range and to explore the possibility of establishing the species DNA barcode. AFLP analysis showed large genetic differentiation among populations as well as moderate correlation between genetic distance among populations and geographic distance among locations. MatK has not proven useful in distinguishing S. subspicata from sympatric species. However, nrDNA sequences provided necessary resolution power, with ITS2 being more informative. Estimates of evolutionary divergence between nrDNA sequences obtained in our research and homologous sequences of sympatric Satureja deposited in the GenBank reveal closer relationship between geographically proximate populations of different species and slight divergence within S. subspicata sequences pool. This outcome highlights the importance of considering overall genetic diversity across the distribution range of a species when assigning DNA barcode.

Objective: The accuracy and applicability of various cardiovascular disease (CVD) risk calculators may not be same in different populations. Wecompared 5 RFS for CVD risk on patients from Bosnia an...

The research was conducted on a sample including 166 participants - students of 'Combined Technical High School" of male sex from Travnik, who attended physical education classes regularly during the school year. In the research five variables were used to assess morphological status and nine variables to assess motor status of the participants according to the Eurofit Fitness Test Battery. The main aim of the research was to determine quantitative changes in morphological and motor status of secondary school students during one school year under the impact of programme content of regular physical education classes through a longitudinal study. Quantitative changes in morphological and motor status and analysis of differences between the initial and final measurements were determined by analysis of changes under the model of differences and SSDIF analysis (Bonacin, 2004). A hypothetical measurement matrix was defined by projecting the measurement data, and explicating a set of linear shifts on the association matrix resulted in obtaining structural vector describing quantitative changes, while taking into account relations of the initial variables. Results of the SSDIF analysis indicate that a one-year curriculum of physical education has caused statistically significant changes at global level (p = 0.0000) in both investigated areas, but the changes that have occurred are mild and without dramatic changes. Significant quantitative changes in the motor space occurred in body height and weight, and in the triceps skinfold, as well as in the following variables in the motor space: running 105 m (sideways), lifting the trunk from the lying on back position and the hand dynamometry, and the biggest and most statistically significant global quantitative changes occurred in the 20 m test run sideways with progressive acceleration (ATL20 0.8439). Key words: quantitative changes, morphological characteristics, motor skills, Physical and Health Culture Analiza kvantitativnih promjena morfoloko-motoričkih obilježja učenika srednje kole pod uticajem redovne nastave tjelesnog odgoja Istraživanje je provedeno na uzorku ispitanika koji je obuhvatio 166 ispitanika - učenika Mjeovite srednje tehničke kole mukog spola iz Travnika koji su u toku kolske godine redovno pohađali nastavu tjelesnog odgoja. U istraživanju je primijenjeno 5 varijabli za procjenu morfolokog statusa i 9 varijabli za procjenu motoričkog statusa ispitanika prema programu Eurofit baterije testova. Osnovni cilj istraživanja bio je da se longitudinalnom studijom u trajanju jedne kolske godine utvrde kvantitativne promjene morfolokog i motoričkog statusa učenika srednje kole pod utjecajem programskih sadržaja redovne nastave tjelesnog odgoja. Kvantitativne promjene morfolokog i motoričkog statusa i analiza razlika između inicijalnog i finalnog mjerenja utvrđeni su analizom promjena pod modelom razlika i SSDIF analizom (Bonacin, 2004). Projekcijom podataka mjerenja definisana je hipotetska matrica mjerenja, a eksplikacijom skupa linearnih pomaka na matricu asocijacije dolazi se do strukturnog vektora koji opisuje kvantitativne promjene, uvažavajući relacije inicijalnih varijabli. Rezultati SSDIF analize ukazuju da je jednogodinji nastavni program tjelesnog odgoja izazvao statistički značajne promjene na globalnom nivou (p = 0.0000) u oba istraživana prostora, ali su nastale promjene blage i bez dramatičnih promjena. Do statistički značajnih kvantitativnih promjena u motoričkom prostoru dolo je u tjelesnoj visini i težini, te kožnom naboru tricepsa, a u motoričkom prostoru u varijablama: trčanje 105 m (tamo-ovamo), dizanje trupa iz ležanja na leđima i dinamometrija ake, a najveće i statistički najznačajnije globalne kvantitativne promjene desile su se u testu trčanje na 20 m tamo - ovamo sa progresivnim ubrzavanjem (ATL20 0.8439). Ključne riječi: kvantitativne promjene, morfoloke odlike, motoričke spsosobnosti, tjelesna i zdravstvena kultura

Objective - To present the most efficatious management of raised intracranial pressure after severe trauma brain injury in a pediatric patient. Case report - A 5-year-old Caucasian presented to the emergency room due to head injury caused by falling down stairs. At the time of admission the patient was comatose with pediatric Glasgow Coma Score 6 (V-1, E-1, M-4) and signs of recent posterior head trauma. Computed tomography (CT) scan showed a multifragmented fracture of the occipital bone above the “sinus lake” causing an epidural mass, contusion in the right cerebellar hemisphere, a skull base fracture without signs of midline shifting. Six hours later, during monitoring in the intensive care unit, the patient became cardiorespiratory unstable with signs of uncal brain herniation and Cushing’s triad. Control CT revealed previously verified posttraumatic changes with new signs of decompensating internal hydrocephalus. Considering that evacuation of the epidural collection and decompression of impaired bone fragments in the area of the “sinus lake” would be too risky, extraventricular drainage as the first tier management was properly selected as the option of treatment. Taking into account the hazard / benefit ratio it was shown to be the most effective form of treatment, which was confirmed after six-month follow-up without any form of neurocognitive impairment. Conclusion – Treatment of traumatic brain injury (TBI) in the pediatric population requires a multidisciplinary approach. Different mechanisms of pediatric TBI injury vary widely by age groups and its impact on the development of primary and secondary brain lesions differs. Although many general principles of managing pediatric TBI are similar to adults, cerebral plasticity is one of the features which ultimately always leaves space for a better final outcome of treatment.

Summary Background FTO, a gene recently discovered in genomewide associated studies for type 2 diabetes mellitus (T2D), play an important role in the management of energy homeostasis, nucleic acid demethylation and regulation of body fat mass by lipolysis. The aim of this study was to analyze the association of FTO rs8050136 A>C genetic variant with clinical and biochemical parameters of T2D in the population of West Balkan region (Bosnians and Herzegovinians and Kosovars). Methods The study included 638 patients with T2D and prediabetes and 360 healthy controls of both genders, aged from 40 to 65 years. Patients were recruited at the Clinical Centre University of Sarajevo, University Hospital of Clinical Centre in Banja Luka, General Hospital in Tešanj and Health Centre in Prizren. Genotyping of analyzed FTO polymorphism rs8050136 A>C was performed by qPCR allelic discrimination. Results Genotype frequencies of the analyzed polymorphism were comparable between patients with T2D, prediabetic patients, and healthy population. Logistic regression analyses didn’t show significant association of FTO rs8050136 A allele with increased risk of T2D. However, risk A allele was significantly associated with higher levels of HbA1c, insulin, HOMA-IR index, diastolic blood pressure, and inflammatory markers (fibrinogen and leukocytes) as well as showed tendency of association with increased values of obesity markers (BMI, waist and hip circumference). Conclusions Results of our study showed a significant association of FTO genetic variant rs8050136 A>C with the major markers of insulin resistance, obesity and inflammation, opening new avenues for solving many unclear questions in the pathogenesis of T2D.

In 2012, a European initiative called Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile localised scleroderma (JLS) is a rare disease within the group of paediatric rheumatic diseases (PRD) and can lead to significant morbidity. Evidence-based guidelines are sparse and management is mostly based on physicians’ experience. This study aims to provide recommendations for assessment and treatment of JLS. Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was formed, mainly from Europe, and consisted of 15 experienced paediatric rheumatologists and two young fellows. Recommendations derived from a validated systematic literature review were evaluated by an online survey and subsequently discussed at two consensus meetings using a nominal group technique. Recommendations were accepted if ≥80% agreement was reached. In total, 1 overarching principle, 10 recommendations on assessment and 6 recommendations on therapy were accepted with ≥80% agreement among experts. Topics covered include assessment of skin and extracutaneous involvement and suggested treatment pathways. The SHARE initiative aims to identify best practices for treatment of patients suffering from PRDs. Within this remit, recommendations for the assessment and treatment of JLS have been formulated by an evidence-informed consensus process to produce a standard of care for patients with JLS throughout Europe.

Abstract Recurrent myocarditis is rare with only few reports having been published for paediatric cases. Repeated use of extracorporeal membrane oxygenation is also uncommon. In this paper we will present a very rare case of a 7-year old girl with recurrent fulminant myocarditis with heart failure requiring cardiopulmonary resuscitation and mechanical circulatory support with extracorporeal membrane oxygenation. Both episodes were precipitated by a viral upper respiratory tract infection, and in both cases the cardiac function eventually completely recovered. The second episode of fulminant myocarditis was particularly complex with markedly elevated markers of myocardiocytolysis, multiorgan dysfunction and the need for prolonged mechanical circulatory support. Nevertheless, the patient made a remarkable recovery. A comprehensive diagnostic workup pointed towards an aberrant immune response as the likely cause of the girl’s susceptibility for fulminant myocarditis.

Introduction: The concept of quality of life (QoL) is becoming an increasingly important criterion in the assessment of treatment outcomes, health outcomes and in the assessment of the benefit-to-load ratio of drugs or therapies that have equivalent mechanisms of action. Aim: The aim of the study was to evaluate the improvement of quality of life, tolerability of therapy and patient compliance in patients with depression and/or anxiety disorder treated with antidepressants. Methods: The study was designed as a clinical, multicenter, prospective, cohort study involving 682 patients of both sexes diagnosed with depression and/or anxiety disorder observed over the 9 months period. The study was conducted from January to December 2017 in six research centers of the PI Health Center of the Canton of Sarajevo. The patients were divided into three groups: depressive, anxious and mixed anxiety-depressive disorder, and the therapy administered was, paroxetine or escitalopram. MOS (Medical Outcomes Study) sleep scale and Q-LES-Q-SF (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form) scale were used for quality of life evaluation. Patients were observed six times over the course of the study. Results: The results of the MOS questionnaire showed that more than 90 percent of patients with depression and/or anxiety disorder who had taken fluoxetine, paroxetine or escitalopram for 36 weeks experienced an improvement in the sleep problem index. Sleep duration was greatly improved in all patients regardless of the antidepressants used. The results of the Q-LES-Q-SF questionnaire showed a significant improvement in quality of life as well as overall pleasure and satisfaction with life due to the use of antidepressants. Conclusion: Therapy with fluoxetine, paroxetine and escitalopram leads to a significant improvement of all recorded parameters, along with the overall quality of life, which makes them very effective in the treatment of depression and/or anxiety disorders.