SUMMARY – Spinal dumbbell tumors are defined by a narrowing at the point where they penetrate the intervertebral foramina or dura mater, assuming an hourglass or dumbbell shape. Dumbbell-shaped spinal hemangiomas are extremely rare. We describe a dumbbell spinal tumor (epidural cavernous hemangioma) resected by a 2-stage single-sitting combined approach. We also conduct a substantial literature review of the subject. We present a case of a 78-year-old male who was found to have a homogeneously enhancing, dumbbell-shaped, intraspinal, extradural tumor mass extending into the left chest cavity. The tumor was resected with a single-sitting 2-stage posterior technique: a microsurgical approach, followed by endoscopic resection via a thoracoscopic approach. There are several reports in the literature on the combined approach for dumbbell tumors of the spinal cord. Our case is the first to describe 2-stage combined surgery in 1 sitting for dumbbell hemangioma with the patient in the lateral decubitus position for the thoracoscopic part of the surgery; and the use of a fat pad, which was applied in the neuroforamen via the posterior route, as a marker for resection during the transthoracic procedure.

Introduction: Cervical erosion and squamouse intraepithelial lesion of low grade are most common gynecological problems of women. These changes on cervix are cause of painful coitus and enhanced vaginal secretion. Cryotherapy is widely accepted method in treating these changes and sympthoms. Aim: The aim of this study is to examine the efficiency of cryotherapy in eliminating erosion of cervics and LSIL, as well as conditions following these states. Patients and methods: Cryotherapy was performed in 124 women with cervical erosion (N-74) and LSIL (N-50). Sympthoms that were followed are: vaginal secretion, abnormal vaginal bleeding and pain. Assessment of epithelisation of cervix and evaluation of sympthoms were done 4 and 6 weeks after cryotherapy and PAP test after 4 months in women with LSIL. Statistical method used in result processing was X2 test. Results: The average age of examined women is 37,75±8,2. Enhanced vaginal secretion had 87,09% (N-120), painful coitus 61,29% (N-76), pain in lesser pelvis 52,41% (N-65) and abnormal vaginal bleeding 28,22% (N-35). Erosion of cervix had 14% (N-7) of women with LSIL. After cryotherapy, enhanced vaginal secretion remained in 21,77% (N-27) of women, painful coitus remained in 8,06% (N-10), pain in lesser pelvis remained in 5,6% (N-7) and abnormal vaginal bleeding in 6,4% (N-8). Four weeks after cryotherapy, complete epithelisation of cervix was in 87,90% (N-109) and after six weeks in 93,54% (N-116) of examined women. LSIL was eliminated in 92% (N-46) of women after cryotherapy and in 8% (N-4) results remained the same. Conclusion: Cryotherapy is successful method of elimination of cervical erosion, LSIL and pains with enhanced vaginal secretion.

Colorectal cancer (CRC) represents one of the most common cancers. It is frequently diagnosed at advanced stages, indicating on need for new diagnostic markers. The aim of this study was to determine systemic and fecal values of IL-17 and IL-33 in patients with CRC and the relationship with clinicopathological aspects of disease. The blood samples and feces liquid fraction of 50 patients with CRC were analyzed. Serum and fecal levels of IL-33 and IL-17 were measured using sensitive enzyme-linked immunosorbent assay (ELISA) kits. Fecal levels of Il-33 and IL-17 were increased in CRC patients with poor tumor tissue differentiation. Serum IL-33 and fecal IL-17 were increased in patients with presence of lung/liver metastasis or peritoneal carcinomatosis, respectively, while enhanced fecal IL-33 was detected only in patients with peritoneal carcinomatosis. Positive correlation between IL-33 and IL-17 values in sera and feces, respectively was also observed. We believe that increased local values of IL-33 and IL-17, reflected trough higher fecal concentration, in CRC patients with poor tumor tissue differentiation and with presence of lung/liver metastasis or peritoneal carcinomatosis may be considered as a sign of the tumor’s malignant progression and, consequently, of a poor prognosis for patients.

Introduction: Osteoarthritis (OA) is the most common joint disease in the world. At the end stage of the disease, usually when patients cannot handle the pain anymore, the knee replacement surgery is the most common and effective treatment to reduce pain and improve functionality. The effect of preoperative exercise (prehabilitation) for patients undergoing total knee arthroplasty (TKA) is still controversial. Aim: To investigate the effect of prehabilitation on postoperative outcome and compare the results of the intervention with the control group. Material and Methods: This prospective study included 20 patients with a diagnosis of gonarthrosis, aged 48-70, who were randomly allocated to either the intervention group or control. Ten patients (intervention group) underwent a 6-week home-based exercise program before the TKA surgery. All patients were assessed by Knee Score (KS), Function Score (FS), and Body Mass Index (BMI) according to the following schedule: 6 weeks before surgery (for intervention group it meant before the prehabilitation program), just prior to surgery (for intervention group it meant after the prehabilitation program), after the surgery, at 3rd month, 6th month, and 12th month postoperatively. They were all operated by the same surgeon, for the primary total knee replacement (Zimmer NexGen Complete Knee Solution) at the Clinic for Orthopaedics and Traumatology, Clinical Centre University of Sarajevo, from October 2016 to June 2017. Results: There is statistically significant difference for Knee and Function Score between the intervention and control group in testing time: just before surgery–meaning that KS and FS increased after the prehabilitation program. Knee Score was significantly different between the two observed groups postoperatively, 3 months postoperatively and 6 months postoperatively, while the Function Score was not significantly different in that period. Prehabilitation program provides better preoperative KS and FS, and better KS up to 6 months postoperatively. However, 12 months postoperatively there was no significant difference between the intervention and control group for the Knee and Function Score. Conclusion: Prehabilitation brings significant difference regarding the Knee Score in favor of the intervention group preoperatively and up to 6 months postoperatively.

Introduction: Plasmapheresis is often used as a therapy in the treatment of thrombotic thrombocytopenic purpura (TTP). TTP is manifested in thrombotic microangiopathy, consumed thrombocytopenia, hemolytic anemia and acute kidney injury with HUS development, neurologic dysfunction, and fever. Case report: we will present a case of a patient with acute kidney injury and refractory TTP at the beginning of hospitalization, subsequently manifested in secondary nephrotic syndrome. The patient was a female, 39 years of age, who as an emergency case was referred from the hospital in East Sarajevo to the Clinic of Endocrinology, Diabetes and Metabolism Disorders of the Clinical Center University of Sarajevo with suspected TTP. A few days before hospitalization she had a fever and vomiting, and therefore consulted her physician. She was hospitalized due to severe general condition, generalized edema, visible body hematomas, and diuresis amounting to 600 ml/12 hours. Laboratory results on admission were as follows: Leukocytes 19.5, Erythrocytes 3.23, Hemoglobin 103, Hematocrit 28.8%, Platelets 65.4 with few schistocytes and 2 reticulocytes, Sodium 140 mmol/L,, Potassium 4.5 mmol/L, Calcium 1.90 mmol/L, Glucose 7.9 mmol/L, Urea 37.5 mmol/L, Creatinine 366 umol/L,, Bilirubin 19.0 umol/L, Lactate dehydrogenase 1194 U /L. The patient was communicative, in cardiopulmonary sufficient state. Central venous catheter was placed in the right jugular vein and the first plasmapheresis was performed. During the hospitalization 38 plasmapheresis treatments with frozen plasma were performed, followed by three Rituximab treatment cycles. After the last plasmapheresis treatment a platelet count was 138. Also, parameters of the renal function were in their referent values. At the beginning of the treatment proteinuria was 19.6 g/24 hours urine. We were faced with a dilemma whether renal biopsy should be repeated in the future given that it might be the case of primary and not secondary nephrotic syndrome. Controlled proteinuria was 4.7g after plasmapheresis. The patient used only Prednisolone at a dose of 10 mg daily and although initially diagnosed with acute kidney injury she was not treated with dialysis. Conclusion: early diagnosis and early start of plasmapheresis therapy is vital for treatment of patients with acute kidney injury and TTP (HUS). A small number of patients is refractory to plasmapheresis and introducing Rituximab and plasmapheresis treatment is recommended.

Abstract Patient satisfaction is a key indicator to assess the quality of gastrointestinal endoscopy. The aim of this study was to examine the Serbian translation and cross-cultural validation of the questionnaire for the assessment of satisfaction in patients who underwent gastrointestinal endoscopy. After obtaining the consent of the author of the original questionnaire, translation and cross-cultural validation of the GESQ (Gastrointestinal Endoscopy Satisfaction Questionnaire) were carried out in accordance with the conductors of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The study was conducted in the Center for Gastroenterohepatology (GEH) of the Kragujevac Clinical Center and included 165 patients. The reliability of the Serbian translation of the GESQ was estimated by calculating Cronbach’s alpha for the whole questionnaire in order to implement the structural validation. The overall score of the questionnaire was compared and correlated with the total scores on the Short Subjective Well-being scale (KSB) and visual analogue scale (VAS), which were administered to the same patients. The Serbian translation of the GESQ showed high reliability with a Cronbach’s alpha coefficient of 0.763, good structure and homogeneity by randomly sharing the questionnaire into two parts. Exploratory factor analysis indicated the existence of four factors that explain 57.200% of the variability. The Serbian version of the GESQ showed similar psychometric characteristics to the original English questionnaire, with a similar factor structure, and represented a valid, reliable and acceptable tool for the assessment of patient satisfaction with the endoscopic examination of the digestive tract.

Introduction: Between 30 to 59% of patients with migraine without aura are undiagnosed and improperly treated, because primary care physicians are either too busy or unfamiliar with criteria for diagnosing migraine. Aim: The aim of our study was to translate the Migraine Screen Questionnaire (MS-Q) to BHS (Bosnian/Croatian /Serbian) language and to test reliability and validity of the translation on a sample of primary care patients. Material and Methods: The study was designed as cross-sectional, multi centric, diagnostic accuracy trial of an instrument for screening patients who visit general practitioners, with an aim to reveal migraine without aura. The instrument was the MS-Q, originally written in English and validated in Spanish population, and in this study being translated to BHS language. Results: Translation of the MS-Q to BHS language showed good diagnostic accuracy (sensitivity 80.0% and specificity 87.2%) and reliability (Cohen kappa 0.648) for migraine without aura, with significant screening yield among previously undiagnosed patients of 72.7%. The study also confirmed high percentage of patients with hidden MWA (52.9%) revealed by the MS-Q and ICH criteria that would otherwise remain undiagnosed. Conclusion: The MS-Q translation to BHS language could be considered as valid and reliable clinical instrument for revealing migraine without aura, similar by its performance to original questionnaire. It has considerable screening yield, discovering majority of patients with previously undiagnosed migraine without aura, whose definite diagnosis should later on be confirmed by the attending physicians using the ICH criteria.

Abstract Potentilla reptans is a little studied plant of the genus Potentilla, the family Rosaceae. The aim of this study is to determine antimicrobial effects of aqueous extracts of P. reptans aerial part and rhizome against standardized bacterial strains. The antimicrobial activity of aqueous extracts of P. reptans aerial part and rhizome was tested against one fungus, Candida albicans, and two standard bacterial strains, Staphylococcus aureus and Escherichia coli, using an agar diffusion method. Both examined extracts showed a significant antimicrobial activity against Escherichia coli and Staphylococcus aureus at the concentrations of 10 to 150 mg/ml. The rhizome extract showed stronger antimicrobial effect against the tested strains of bacteria than the aerial part extract. The obtained results represent preliminary results of antimicrobial activity of this plant and suggest that in future, the studies should examine antimicrobial activity against other bacterial strains and minimum inhibitory concentration.

Ovaj rad daje osvrt na stanje standardizacije u oblasti informacijske i bibliotečke djelatnosti u Bosni i Hercegovini, kroz rad dva tehnička komiteta Instituta za standardizaciju BiH. Informatizacija društva, kakva je opisana u strateškim dokumentima iz prethodne decenije, realizirana je ne zahvaljujući, nego uprkos podršci države. Složena politička i teška socijalna situacija u BiH nisu bile prepreka da po broju korisnika interneta budemo iznad svjetskog prosjeka. Na primjeru akademskih i istraživačkih mreža pokazano je da ipak zaostajemo u brzinama pristupa internetu, koje su među najnižim u regiji. IT industrija, kao perspektivna privredna grana, sama čini napore i vrši pritisak na državu da se učini više na razvoju ove djelatnosti, prvenstveno u sektoru obrazovanja. Na kraju rada dat je kritički osvrt na pojam Big Data i njegovu primjenu u naučnim podacima, koji čine usko specijalizirani dio bibliotečke djelatnosti, te ulogu standardizacije u toj oblasti.

Background: This cost-of-illness (COI) study provides deep insight in direct and indirect costs of multiple sclerosis (MS) in Bosnia and Herzegovina (BH). Aim: Objective of this study was to analyze the costs and quality of life (QoL) of patients with MS in BH. Patients and methods: We applied the same methodology already used in study conducted across nine European countries. Sixty-two patients participated with EDSS score not higher than 6.5. Costs are collected using a questionnaire quality of life was measured by EQ-5D and MSQOL-54 questionnaires. Results: Mean age of respondents was 39.8 The mean utility measured by EQ-5D-3L was 0.68 at the beginning and 0.63 at the end of the study. QoL measured by MSQoL-54 showed improvement at the end of the trial. Costs are presented from the societal and payer perspective. Cost of MS in Bosnia and Herzegovina annually amount 124.8 million BAM. Cost driver where indirect and DMDs costs, with significant differences among subgroups. Conclusions: This study provides an in-depth analysis of MS costs in BH providing data for health policies development and information for future cost-effectiveness evaluations of new therapeutic options as well as for comparison of MS costs with other countries.

Today’s modelling approaches in Systems Medicine are increasingly multiscale, containing two or more submodels, where each operates on different temporal and/or spatial scales. In addition, as these models become increasingly sophisticated, they tend to be run as multiscale computing applications using computational infrastructures such as clusters, supercomputers, grids or clouds. Constructing, validating and deploying such applications is far from trivial, and communities in different scientific disciplines have chosen very diverse approaches to address these challenges. Within this paper we reflect on the use of Multiscale Computing within the context of Systems Medicine. Multiscale Computing is widely applied within this area, and instead of summarizing the field as a whole we will highlight a set of challenges that we believe are of key relevance to the Systems Medicine community.

Abstract The aim of this paper is to analyze the convergence process among former Socialist countries, the Central and Eastern European (CEE), Western Balkan and Eastern Partnership countries. The relationships between the selected macroeconomic variables and per capita GDP growth rate are econometrically tested to support this research. The analyzed period is 2004-2016, with two sub-periods; 2004-2008 and 2009-2013. The subdivision is made to test if the recent financial crisis affected the absolute and conditional convergence process. The empirical findings support the economic convergence hypothesis. The results show that the recent financial crisis negatively affected only the absolute convergence process. The negative effects of the crisis on conditional convergence are not identified. The poorer countries in the analyzed group should do more to attract investment, as gross fixed capital formation has a clear positive impact on per capita growth in the examined sample of countries.