BACKGROUND Migration of distal ventriculoperitoneal (VP) shunt catheter into another body part has been described as a potentially serious surgical complication. We present the first case of sepsis caused by transcardial and pulmonary migration of distal catheter into the heart and pulmonary artery, which was subsequently colonized by Klebsiella pneumoniae. CASE REPORT A 56-year-old men underwent VP shunt insertion for hydrocephalus that developed after the surgery for intracranial meningioma. Three years later, he was admitted to Department for Infectious Diseases due to persistent fever. Klebsiella pneumoniae was isolated from the blood cultures. Computerized tomography (CT) of the thorax showed migration of the distal catheter into the heart and pulmonary artery. The migrated shunt catheter was retrieved without any complication with the assistance of a cardiovascular surgeon; microbiology confirmed that the catheter was colonized with Klebsiella pneumoniae. We decided to delay new VP shunt placement due to positive blood cultures, and 3 weeks after the surgery, patient was without signs of increased intracranial pressure and without any heart problems. CONCLUSION Migration of a distal VP shunt catheter into the heart should be considered in patients with a previously placed VP shunt presenting with cardiopulmonary problems, arrhythmia, and/or fever. Neurosurgeons should be involved as soon as possible, and a multidisciplinary approach is warranted.

Introduction: After family medicine’s famous beginnings in the early 60’s through introduction of the world’s first family medicine specialization, with transitional changes and war also come changes in former Yugoslavia’s healthcare systems. Aim: The primary aim of this article is to analyze frequency and causes of sanctioning of family physicians by Health insurance funds in the countries of former Yugoslavia. The secondary aim is to evaluate frequency and types of workplace violence family physicians experienced due to insurance boundaries for patients. Methods: The comparative, cross-sectional survey was carried out from October 2017 to February 2018. Study participants were general practitioners’ (GPs), family physicians (FPs) and those without a specialty designation but providing family medicine services in one of the five Western Balkans countries: Croatia, Slovenia, Serbia, Macedonia and Bosnia and Herzegovina (B&H). The questionnaire was designed for the purpose of the study. Results: Forty-nine percent of participating physicians have been sanctioned by Health Insurance Fund and 77. 5% has been exposed to workplace violence. The most common type of violence was verbal (76.6%). Financial penalties according to the scale had the highest rates in Macedonia (73.9%) and Slovenia (43.9%). Conclusion: It is necessary to educate creators of healthcare policies, doctors and patients for the purpose of establishing partner relations which would lead to strengthening of primary healthcare, but also to a more efficient healthcare system.

Introduction: Cytomegalovirus (CMV) infection is ubiquitous. It affects all age groups, and its clinical picture ranges from mild to severe, especially as a congenital infection in neonates. Aim: To determine frequency of CMV infection in pregnant women in Tuzla Canton (TC) and the risk factors that lead to the infection. Methods: This prospective study included 300 pregnant women from TC aged 18 to 42 years. CMV serology was performed on all participants, and in case of acute infection additionally IgG avidity test. Participants also completed the questionnaire on the risk factors for CMV infection. Results: The median age of the 300 women was 28 ±4.97 years. There were 161participants (53.6%) who classified their environment as urban and 295 (98.33%) were married. More than half of the women had completed secondary school 168 (56%). Positive IgG antibodies to CMV had 280 (93.0%) women. Positive IgM and IgG antibodies had 9 (3.0%) participants, but all of them had high IgG avidity, which indicates reinfection or recurrent CMV infection. There was a statistically significant higher number of seropositive participants living in rural areas than those living in urban areas (p= 0.048). Also, there was significantly higher percentage of positive anti-CMV IgG in pregnant women with lower education (p=0.04). Conclusion: In our region there is high seropositivity rates of IgG antibodies to CMV in pregnant women. No case of primary CMV infection was proven. The risk factors for CMV infection have been proven to be rural environment and lower level of education.

Introduction: To the best of our knowledge, this is the first study about malignant eyelid tumors in the region of Tuzla, Bosnia and Herzegovina, and it shows similar results comparing with other countries (the annual incidence of eyelid tumors in Tuzla region is about 3.73/100 000 population). Malignant eyelid tumors are relatively uncommon, but potentially fatal disease. However, if detected early and treated adequately, the prognosis is generally excellent. Aim: The aim of this study was the clinical and microscopical analysis of malignant eyelid tumors in treated patients, the presentation of surgical treatment and reconstructive methods of eyelid tumors. Methods: This retrospective study included 60 patients surgically treated at the University Clinical Center Tuzla from January 2012 to December 2016, who were initially diagnosed with malignant eyelid tumors in accordance to the final results obtained by histological examination of excised lesions. Results: In the group of malignant tumors, the most common tumors were BCC (85%), which were predominantly found on the lower eyelids (92.16%) and showed female predominance (51.06%). SCC was the second most common eyelid malignancy (15%) and showed a predilection for the lower eyelid involvement and male predominance (55.56%). Tumors up to 2 cm in diameter (clinical stage T1) were found in 78.33% of cases, 95.74% of which with radical excision, while 4.26% with non-radical excision. Conclusion: Treatment by complete excision with histological confirmation of tumor clearance is recommended. Perineural spread is an adverse prognostic sign, which may require postoperative radiotherapy. Orbital invasion is a rare complication but, if recognized early, it can be treated effectively with exenteration. Because presentation varies and histological examination is required for accurate diagnosis, any suspicious lesion occurring on the eyelids should be excised or biopsied. All patients with malignant tumors should be advised of the risk of recurrent or new tumors and encouraged to attend lifelong follow up.

Aim To investigate the prevalence of common genetic variants that can serve as markers of thrombophilia and warfarin pharmacogenetics in Bosnia and Herzegovina. Methods The study was performed between August and October 2017 on 130 healthy unrelated adult volunteers from Bosnian-Herzegovinian population sample. The prevalence of the following genetic variants was determined: F5 c.1601G>A (factor V Leiden), F2 c.*97G>A (factor II or prothrombin mutation), F13A1 (factor XIII) c.103G>T, MTHFR (methylenetetrahydrofolate reductase) c.665C>T and c.1286A>C, as well as PAI-1 (plasminogen activator inhibitor 1) c.-816A>G and c.-844G>A as markers of thrombophilia risk, and *2 and *3 alleles of CYP2C9 (cytochrome P450 2C9) and five variants of VKORC1 (vitamin K epoxide reductase complex subunit 1) as markers of warfarin pharmacogenetics. DNA was isolated from buccal swabs using salting out method, while genotyping was performed using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. Results Minor allele frequencies for two main thrombophilia risk factors, F5 c.1601G>A and F2 c.*97G>A were 0.023 and 0.008, respectively. Combined data for the markers of warfarin pharmacogenetics imply that 57.4% study participants can be expected to metabolize warfarin at an extensive, 40.3% at intermediate, and 2.3% at a poor rate. Conclusion This study reports the first extensive population genetic data for thrombophilia and warfarin pharmacogenetic markers in Bosnia and Herzegovina. Allele frequencies of genetic variants are within the general average for European populations, and their presence implies the necessity of introduction of personalized medicine in warfarin-mediated antithrombotic therapy.

Aim: The aim of this paper was to evaluate the incidence of thyroid gland diseases in relation to age, sex, existing associated symptoms and thyroxine and thyroid-stimulating hormone levels, in correlation with morphological characteristics and corresponding clinical diagnosis for thyroid gland. Methods: Retrospective research was conducted in the period 1-Dec-2017 to 31-Dec-2017 and included a total of 500 subjects of both sexes aged 1 to 80 years. All subjects had clinical examination, which included anamnestic data, palpatory examination of thyroid gland, as well as functional status of thyroid gland. Results: The results of the research have shown that majority of subjects were females (78.6% vs. 21.4%). The largest number of subjects was in the age group 41 to 60 years. The average age of females was 43.22 years and 42.86 for males. The most common associated symptom for both sexes was related to cardiovascular system disorder (61.2%). Subclinical hypothyroidism was the most prevalent thyroid gland disease (12.8%), while diffuse enlargement of thyroid gland (4.60 %) was the most common in morphological classification. The mean value for free thyroxine for the overall sample was 14.39 pmol/L and 3,4 mlU/L for thyroid-stimulating hormone. Thyroid-stimulating hormone levels were highest in the age group 41-60 years (p=0.043). Conclusion: The overall incidence of thyroid gland diseases was 18.57% for females and 13.08% for males. Free thyroxine levels were highest in thyroid gland with nodular changes and subclinical hypothyroidism (p=0.0001). Thyroid-stimulating hormone levels had the highest value in a thyroid gland with diffuse changes and subclinical hypothyroidism (p=0.0001).

Introduction: Pathology of thyroid nodules is present in all ages and it is frequently encountered in clinical practice. Thyroid nodules do not represent a single disease, but they are the clinical manifestation of a wide range of different thyroid diseases. Aim: The objective of this study is to evaluate the frequency and localization of malignancy in solitary scintigraphic cold nodules, as well as the sensitivity, specificity and diagnostic accuracy of FNAB in comparison with histopathological findings. Methods: The study was included 49 patients with palpatory findings of the solitary nodule located in the both lobes or isthmus of thyroid gland. All subjects underwent the scintigraphy and FNAB, followed by a cytologic results that was compared to the final histopathological diagnosis, after surgery. Results: The study results show that the highest number of solitary nodules (81,6%) is localized in the lower pole of the both lobes of the thyroid gland. The cytologic results were benign 8 cases, malignant in 23 and indeterminate (follicular neoplasm) in 18 cases. The highest number of thyroid cancer is histopathologically confirmed in the patients with cytological diagnosis of follicular neoplasms, i.e. follicular cancer is found in 66.7% and papillary cancer is found in 33.3% of subjects. The most common cancer is papillary cancer found in 61,2%. Since the pathohistological diagnosis of all our patients responded to cancer, it was done indirect statistical evaluation of the diagnostic sensitivity of cytological method in the estimation of malignant thyroid lesion, which was 83,7%. Conclusion: FNAB is a highly sensitive method in the diagnostics of malignant thyroid lesions with the sensitivity Se=83,7%. The highest number of thyroid cancer is histopathologically confirmed in the patients with cytological diagnosis of follicular neoplasm (66.7%). The highest number of patients had a cytological diagnosis of papillary cancer.

Objectives Space flight diets include a 55/30/15 (carbohydrate/fat/protein) ratio. Yet recent long-term missions require astronauts to exercise several hours daily for up to seven days a week. We hypothesize a high protein diet (45/25/30) is more conducive to longer missions and their high volumes of exercise. Methods With a within-subjects design, participants (8 men, 8 women) adhered to each diet for 14 days. Isocaloric diets were prescribed based on subject's resting metabolic rate, activity level and body composition. Compliance was monitored daily. Per subject, diet sequence was randomized to limit order effects. Immediately after each diet concluded subjects worked out on a gravity-independent device (Impulse Training Systems; Newnan, GA) while tethered to a metabolic cart. Workouts entailed four (unilateral knee extension, unilateral hip extension, unilateral standing row, bilateral arm pulldown) exercises, comprised of three 60-second sets separated by 60-second rests and done against 4.4 kg. Work volumes were measured from our device, as were pre-exercise respiratory quotients (RQ), and energy costs based on net O2 uptakes. Blood lactate concentrations ([BLa-]) were measured before and five minutes after workouts. Exercise and respiratory data were compared with 2(gender) × 2(diet) ANOVAs, with repeated measures for diet. [BLa-] were assessed with a 2(gender) × 2(time) × 2(diet) ANOVA, with repeated measures for time and diet. Results Significant [BLa-] differences occurred for time (post > pre) and for RQ by diet (55/30/15 > 45/25/30). Trends for work differences occurred by gender (men > women) and diet (45/25/30 > 55/30/15). Conclusions Our preliminary results concur with those that show greater RQ values from diets higher in carbohydrates. With continued data collection it is of interest to note if inter-work differences reach statistical significance, with higher values produced by the high protein diet. If so, such a diet may be more efficacious as a countermeasure to the muscle atrophy, strength loss and performance decrements for in-flight operational tasks seen with longer missions. Funding Sources Kentucky Space Grant Consortium.

Chen, L, Davison, SW, Selimovic, EA, Mueller, RE, Beatty, SR, Carter, KA, Parmar, PJ, Symons, TB, Pantalos, GM, and Caruso, JF. Load-power relationships for high-speed knee extension exercise. J Strength Cond Res 33(6): 1480-1487, 2019-Seventy subjects did 4 knee extensor workouts with their left legs to assess load-power relationships produced on a high-speed trainer (HST; Newnan, GA, USA). Each workout is composed of 4 sets done on the HST at a different load (1, 4.4, 6.7, 9 kg). A Latin Squares Design determined load sequence per workout. Average power (AP) and peak power (PP) and those same values normalized to body mass (BM) and fat-free mass (AP/BM, PP/BM, AP/FFM, PP/FFM) were each analyzed with 2 (gender) × 4 (load) analysis of variances, with repeated measures for load. We assessed relationships between normalized loads and AP and PP values with correlation coefficients. Average power results revealed a significant interaction, with men > women at 9 kg. Peak power/body mass also yielded an interaction, with women > men at 6.7 and 9 kg. Average power/fat-free mass and PP/FFM each produced interactions, with women > men at 4.4, 6.7, and 9 kg. Correlation coefficients showed significant (r = 0.80-0.82) relationships between normalized loads and AP and PP values. In conclusion, the very low inertial resistance to initiate each repetition on this novel device may in part explain our PP/BM, AP/FFM, PP/FFM results, in which higher values were achieved by women. Our practical applications imply that the low inertial resistance for HST repetitions negates male size and strength advantages typically seen when power is measured.

Methylating substances alter DNA by forming N3‐methylthymidine (N3mT), a mutagenic base modification. To develop a sensitive analytical method for the detection of N3mT in DNA based on capillary electrophoresis with laser‐induced fluorescence detection (CE‐LIF), we synthesized the N3mT‐3’‐phosphate as a chemical standard. The limit of detection was 1.9 amol of N3mT, which corresponds to one molecule of N3mT per 1000 normal nucleotides or 0.1%. With this method, we demonstrated that the carcinogenic nitrosamine N’‐nitrosonornicotine (NNN) induced N3mT in the human lung cancer cell line A549. Treatment with NNN also caused an elevated degree of 5‐hydroxymethylcytidine (5hmdC) in DNA, while the methylation degree (i.e. 5‐methylcytidine; 5mdC) stayed constant. According to our data, NNN could, via yet unknown mechanisms, play a role in the formation of N3mT as well as 5hmdC. In this study we have developed a new sensitive analytical method using CE‐LIF for the simultaneous detection of the three DNA modifications, 5mdC, 5hmdC and N3mT.

In this article we shortly present new string pattern matching algorithm. The algorithm uses novel technique for skipping unnecessary comparisons in pattern searching phase. The pattern searching is applied in almost all branches of science such as bioinformatics, information security, text mining, etc. In the context of continuous increase of data, efficient algorithms are necessary to ensure that one can find a pattern in a sequence in a fast and accurate manner. Pattern searching solves the problem of finding a pattern exhibiting certain properties within a given sequence of symbols. Concept of the new algorithm presented in this article is based on a character index in a pattern, aiming at, but not limited to patterns in DNA sequences.