BackgroundDairy production in Bosnia and Herzegovina exhibits limited productivity, which may partly, be explained by extensive reproductive problems of non-infectious and infectious origin. Brucella spp., Chlamydia abortus, Coxiella burnetii and Neospora caninum are common infectious causes of decreased reproductive outcomes in cattle worldwide. Little is, however, known about the disease status of herds with reduced reproductive performances. A cross-sectional study was designed to document the status of these pathogens in dairy cattle in Bosnia and Herzegovina. A total of 1970 serum samples were collected from cattle in farms located in three cantons (regions). Enzyme linked immunosorbent assays were used to screen for seropositivity against four selected pathogens.ResultsThe overall seroprevalence was estimated at both the herd level and at individual level for each pathogen. At the individual animal level, the prevalence for C. abortus, C. burnetii, N. caninum and Brucella spp. was 52.1% (95% CI: 41.2–62.7), 8.8% (95% CI: 5.3–14.2), 9.2% (95% CI: 6.0–12.3 and 0.2% (95% CI: 0.1–0.5), respectively. The corresponding estimates for herd level were 87.9% (95% CI: 82.6–91.8), 19.6% (95% CI: 14.6–25.8), 35.2% (95% CI: 28.8–42.1), and 1.5% (95% CI: 0.5–4.6). A substantial overlap was observed in the presence of N. caninum, C. abortus and C. burnetii at individual and herd level.ConclusionOur study demonstrated a high level of antibodies to Chlamydia abortus. Considering the association of this agent with reproductive disorders in cattle, future studies should be directed to the epidemiological traits of this infection. Additionally, the relatively high levels of exposure to C. burnetii and N. caninum found in this study highlights the need for targeted control of infectious causes of reproductive disorders in dairy cattle of the studied areas. Given the low seroprevalence, Brucella spp. does not seem to represent a problem in the reproductive health of cattle in the studied areas.

Introduction The aim of the study was to investigate the effects of vascular endothelial growth factor (VEGF) concentration in vitreous on postoperative complications after pars plana vitrectomy (PPV). Material and methods Ninety subjects were surgically treated with PPV and followed up for 12 months at the Clinical Centre University Sarajevo, Clinic for Eye Disease. Exclusion criteria were presence of other eye diseases, systemic acute/chronic inflammatory conditions, or malignant neoplasms; previously performed PPV surgery; previously received intravitreal or systemic anti-VEGF therapy. A vitreous sample was obtained while performing the PPV procedure, using the Quantikine ELISA test to determine VEGF level, as a risk factor. Outcome measures were intraoperative and postoperative complications reported using categorical data: blunt and sharp dissection of membranes, intraoperative hemorrhage stopped by increasing infusion pressure, pressing with blunt instrument, or using diathermy. The following postoperative complications were assessed on the first day and at the 12-month follow-up visit: vitreous hemorrhage, fibrovascular proliferation (FVP), rubeosis iridis, and neovascular glaucoma (NVG). Results Levels of vitreous VEGF at the time of PPV were significantly higher in eyes with: vitreous hemorrhage on the first day after PPV (p = 0.003); FVP on the first day and 12 months after PPV (p = 0.002 and p < 0.001, respectively); iris rubeosis on the first day and 12 months after PPV surgery (p < 0.001, and p = 0.001, respectively); NVG on the first day and 12 months after PPV surgery (p = 0.043 and p = 0.011, respectively), compared to the eyes without complications. Conclusions Preoperative levels of VEGF in vitreous can be a useful biomarker and predictor of the postoperative outcome in terms of intraoperative and postoperative complications.

Aim To explore the experience of registered nurses in assessing pain in hip fracture in patients with dementia in the postoperative setting. Methods The study questionnaire contained 23 items mainly addressing demographic and social data, information about communication and pain assessment, attention and awareness of the health-care professionals on the ward and suggestions for improving nursing. Results The nurses claimed that they began their assessment of pain in patients with dementia first by observing the patient and making a visual assessment of pain, after which they began to communicate with these patients; majority of dementia patients with hip fractures displayed more facial expressions of pain than patients without dementia. All the nurses agreed that the more severe the patient's dementia was, the less clear the facial expressions and that this in turn made it difficult for the nurses to take care of such patients. Body language was the most common way the patients with dementia and hip fractures expressed their pain. Assessing the pain of a dementia patient with hip fracture and interpreting a non-verbally communicative patient was experienced as very difficult by all the nurses. Conclusion The nurses found that the fact that they had not attended any courses on dementia and pain assessment in those patients made their work more difficult; they need to know more and to have more information about those patients and their needs for a more comprehensive exchange of information between the hospital wards and the patients' care homes.

Objective Demonstration of idiopathic dilated cardiomyopathy with unusual flow, unpredictable clinical picture and complex therapy. Case report Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed. Conclusion The clinical course of dilated cardiomyopathy is extremely unpredictable and therapy is very complex and demanding.

Aim To determine most common factors making patients with high blood pressure seek professionally unacceptable treatment of hypertension at the Emergency Department. Methods The survey was conducted at the Emergency Department of the Primary Health Care in Gradačac on randomly selected 207 patients who requested medical help because of high blood pressure. For all patients arterial blood pressure and body mass index (BMI) were measured. A survey about knowledge and attitudes regarding habits that affect high blood pressure as well as the socio-economic conditions was made. Results Prevalence of 10.3% was found with regard to visits to emergency care by patients due to high blood pressure. Most patients, 127(61.4 %), were overweight and 36(17.4%) were obese. Patients who rarely controlled their blood pressure were more frequent visitors of emergency medical services. Stressful situation occurs as a factor in a variety of forms. The survey showed that 76 (36.7%) patients sought medical help even though they had no blood pressure values that required emergency care. Conclusion Poorly organized health care system with no continuous and comprehensive preventive promotional programs caused by inappropriate use of resources in health care. The reorganization of primary care with full implementation of family medicine and greater integration of family medicine with other levels of the health care system should provide a better control and treatment of other diseases such as hypertension.

Aim To investigate epidemiological characteristics of the measles epidemic (risk factors and reasons for its emergence) in order to establish better control and prevention of future epidemics as well as to determine an influence of poor collective immunization of children against measles on appearance of epidemic disease. Methods An open retrospective epidemiological study of measles infection was conducted during the epidemic in Zenica-Doboj Canton (ZDC) in the period 2014-2015. Disease reports, Disease Reporting Forms for measles and rubella cases and the Bulletin of the Institute for Health and Food Safety Zenica were used for data collection. Results A total of 325 patients with the diagnosis of measles were registered, 262 (80.61%) in 2014 and 63 (19.39%) in 2015 resulting in overall incidence of 81.25/100.000. The majority of patients were aged 0-6 (p<0.05). Of the total number of patients, only 13 (4.73%) were orderly vaccinated (p <0.05). In the period 2009- 2015 in ZDC 25.444 (83.34%) children (p <0.05) were vaccinated with measles, mumps, rubella (MMR) vaccine. Conclusion Results of the study show that the low level of vaccination of children continues to a risk of the emergence of epidemics of measles and other infectious diseases. Therefore, in order to prevent the disease there is a need for a better vaccination campaign.

Background Postoperative bleeding in patients who underwent elective coronary artery bypass surgery (CABG) may increase due to preoperative anticoagulant therapy indicative of their disease - acute coronary syndrome or implanted coronary artery stent. Increased bleeding in many cases requires the use of blood and blood derivatives, and sometimes even reoperation. Their use poses the risk of complications, may extend the hospitalization. Methods Our observation retrospective study included 131 patients, 41 treated with aspirin and 90 treated with aspirin and clopidogrel. All underwent for the first time elective on-pump isolated CABG surgery at Clinic for cardiovascular surgery of Clinical Center University of Sarajevo, in period June 2016 to September 2017. The data were collected from patient’s records. Results Out of 131 patients,73.3% were male. The average age was 62. The average total drainage during the first 48 postoperative hours in ASA group was 1027.4±404.9ml and 1049.8±371.3ml in DAPT group. The mean number of whole blood transfusions in the DAPT group washigher compared to ASAgroup. The average number of fresh frozen plasma were higher in the DAPT group 0.84±0.51 compared to the group ASA 0.39±0.07, as well the average thrombocytes transfusions were slightly higher in the DAPT group. Statistical analysis suggests that there is no significant difference between the observed groups (p>0.05). Also, our study did not show a statistically significant difference between arrhythmia onset, the length of mechanical ventilation, use of protamineand tranexamic acid. Reoperation due to postoperative bleeding was recorded in 2 cases in the DAPT group as well as 2 lethal cases. Conclusion In our study, we could not demonstrate less postoperative bleeding and use of blood and blood products in a group of patients who were preoperatively treated with aspirin compared to patients with dual antiplatelet therapy in the elective isolated CABG surgery.

A sensitive phosphate sensor has been prepared by constructing a solid membrane disk consisting of variable mixtures of silver phosphate, silver sulfide, and PTFE (Type 1 membrane) or silver phosphate, silver sulfide and nanotube (Type 2 membrane). The ternary membranes exhibit greater selectivity over the wide range of concentration. The membrane with the composition of 50.00% PTFE ; 41.66% Ag3PO4 and 8.33% Ag2S was selected as our preferred membrane. The membranes exhibited linear potential response in the concentration range of 1×10–1 to 1×10–5 M. Their detection limit is about 5×10–6 M. The membranes have a long lifetime and can be stored in air when they are not in use. The best performance for nanocomposite sensor was obtained with membrane of the following composition: 78.00% Ag3PO4 ; 20.00% Ag2S, and 2.00% carbon nanoparticles. The membrane had a slope of 32.6 mV toward HPO42- ions in the range between 1×10-1 and 1×10-5 M with a detection limit of 5.45×10–6 M. The proposed sensors were found to be applicable over a pH range between 3 and 7.