Objective – The aim of the paper is to describe the complexity of pertussis-like syndrome in primary health care practice, and to highlight consequences of vaccine hesitancy. Case reports – We described five cases of pertussis-like syndrome in pediatric practice. Patients were unvaccinated or not fully vaccinated against pertussis due to parental refusal. There was intrafamilial and interfamilial spread of infection. Conclusion – Evaluation and treatment of pertussis-like syndrome remain challenging in primary health care practice. Dealing with vaccine hesitancy requires an adequate understanding and answer. Vaccine refusal increases the individual risk of disease but also increases the risk for outbreaks of vaccine-preventable diseases.

Objective ? The aim of the research was to show the occurrence and persistence of measles morbidity over a twenty year period in the area of the Central Bosnia Canton (Bosnia and Herzegovina). Materials and methods ? The research was retrospective and related to the period from 1997 to 2017. The sample comprised a total of 35,199 children. The subjects were considered in relation to their age, gender, place of residence, vaccination status and time of morbidity. Results ? In the period from 1997 to 2017, on average 36 cases of morbidity  caused by measles occurred each year. Most years in this period (13) did not have any registered cases of measles, and in five years the disease occurred sporadically: 1999 (three cases); 2000 (one); 2003 (one); 2005 (two); 2009 (one), and two epidemics occurred: in 1997, with 77 affected children and with an incidence rate in the population under consideration of 218/100,000; and in 2014 with an explosion of measles morbidity, when 639 affected children were registered (1815/100,000). The average coverage with the first dose of MMR vaccine over the last twenty years was 87%, and the poorest results were achieved in 2004, with 64%. Conclusion ? The epidemiological occurrence of measles in the area of four municipalities in central Bosnia is the result of omissions in the routine immunization programme.

Objective – The aim of this paper is to present the epidemiological and clinical characteristics of a measles outbreak in children age 0-18 years, who were hospitalized at the Clinic for Infectious Diseases of the University Clinical Center, Tuzla in the 2014/2015 period. Patients and methods – The target population of this retrospective study were patients in the 0-18 year age group, who were hospitalized at the Clinic for Infectious Diseases during the measles outbreak in 2014/2015. Results – At the Clinic for Infectious Diseases in Tuzla, 341 patients with the clinical characteristics of measles were hospitalized during the period of the measles outbreak in 2014/2015. Of all hospitalized patients 74.7% (255/341) belonged to the age group from 0 to 18 years. Most of hospitalized children, 146 (57.2%) of them, were in the age group from 0 to 6 years, next was the group of children aged 11 to 18 years, 69 (27.1%) of them, followed by the group of children aged from 6 to 10 years, 40 (15.7%) of them. Complications were present in 176 (69.02%) of the hospitalized children. Among the hospitalized children suffering from measles, 92.5% were unvaccinated or incompletely vaccinated, or their vaccination status was unknown. Conclusion – The youngest population is susceptible to a much higher risk of measles. To reduce the incidence of measles in children a high level of immunization is required.

Introduction: Various studies confirm the biocompatibility and efficacy of clips for certain target tissues, but without any comparative analysis of hematological parameters. Therefore, we conducted a study to assess the possible association of the implantation of titanium and plastic clips in the neurocranium with possible morphological changes in the blood cells of experimental animals. Materials and Methods: As a control, the peripheral blood smears were taken before surgery from 12 adult dogs that were divided into two experimental groups. After placing titanium and plastic clips in the neurocranium, the peripheral blood of the first group was analyzed on the seventh postoperative day, while the peripheral blood of the second group was analyzed on the sixtieth day. By microscopy of the blood smears, the following parameters were analyzed: the presence of poikilocytosis of the red blood cells, degenerative changes in the leukocytes and leukogram. Results: There were no statistically significant differences between the mean values of the groups. Monocytosis was detected (first group 22.83 % and second 16.30 %), as well as neutropenia (46.80 %, in the second group). Degenerative changes to neutrophils and the occurrence of atypical lymphocytes were observed in the second experimental group (60th postoperative day). Conclusion: A mild adverse effect from the biomaterials present in the neurocranium of dogs was detected, affecting the majority of leukocytic cells. A chronic recurrent inflammatory process was caused by the presence of the plastic and titanium clips in the brain tissue. No adverse effect of biomaterials on erythrocytes in the neurocranium was detected in the dogs studied. Further studies are necessary to explain the occurrence of degenerative changes in the neutrophils and lymphocytes.

The prevalence of smoking among Croatian adolescents is alarmingly high, but no previous study has prospectively examined the sport- and academic-factors associated with smoking and smoking initiation. This study aimed to prospectively examine the associations between scholastic (educational) achievement and sport factors and smoking in 16- to 18-year-old adolescents. This two-year prospective cohort study included 644 adolescents who were 16 years of age at baseline (46% females). Baseline testing was implemented at the beginning of the 3rd year of high school (September 2014) when participants were 16 years old. Follow-up testing was completed at the end of the fourth year of high school, which occurred 20 months later. The evaluated predictor variables were educational-achievement- and sport-related-factors. The outcome variables were (i) smoking at baseline; (ii) smoking at follow-up; and (iii) smoking initiation over the course of the study. We assessed the associations between predictors and outcomes using logistic regression models adjusted for age, gender, socioeconomic status, and conflict with parents. The educational variables were consistently associated with smoking, with lower grade-point-average (Baseline: odd ratio (OR): 2.01, 95% confidence interval (CI): 1.61–2.55; Follow-up: 1.59, 1.31–1.94), more frequent absence from school (Baseline: OR: 1.40, 95% CI: 1.19–1.69; Follow-up: 1.30, 1.08–1.58), and lower behavioral grades (Baseline: OR: 1.80, 95% CI: 1.10–2.89; Follow-up: 1.57, 1.03–2.41) in children who smoke. Adolescents who reported quitting sports were at greater odds of being smokers (Baseline: 2.07, 1.31–3.32; Follow-up: 1.66, 1.09–2.56). Sport competitive achievement at baseline was protective against smoking initiation during following two-year period (0.45, 0.21–0.91). While the influence of the educational variables on smoking initiation has been found to be established earlier; sport achievement was identified as a significant protective factor against initiating smoking in older adolescents. Results should be used in development of an anti-smoking preventive campaign in older adolescents.

Introduction: Sister Mary Joseph Nodule (SMJN) is a metastatic umbilical lesion secondary to a primary malignancy of any viscera, stomach and colon being most common in men, and ovary in women. Case report: In this article, we present the case of SMJN in a 54-year old female patient. An urgent diagnostic workup was performed with a computerized tomography of abdominal cavity and pelvis showing an expansive tumorous formation covering uterus with a carcinomatosis of peritoneum. After biopsy, immunohistochemical profile suggested adenocarcinoma of the ovarian origin. The patient was then referred to the Oncology Consilier of Gynecology Department and further continued followed by the Oncology team.

Introduction: Tonsillectomy is a frequently used, low-risk surgical procedure. The post-tonsillectomy haemorrhage occurs rarely, but is a life-threatening complication. Some studies show that the surgical technique affects the haemorrhage rate. Aims: To analyse the post-tonsillectomy haemorrhage rate, and to determine whether the effect of the surgical technique on the haemorrhage rate exists. Methods: We retrospectively reviewed data of all patients who underwent a tonsillectomy in three regional ENT departments in Bosnia and Herzegovina (Tuzla, Zenica and Bihac) between January 1st 2015 and October 31st 2016. Disorders which could affect the post-tonsillectomy haemorrhage rate were excluded. Tonsillectomy techniques used in these three centers were the hot technique (monopolar/bipolar forceps dissection and haemostasis) and the combined technique (cold steel dissection with monopolar/bipolar forceps haemostasis). Results: 1087 patients that underwent a tonsillectomy were analysed in this study. 864 (79.48%) of those were children. 922 (84.82%) patients were operated using the combined technique, 165 (15.17%) underwent a tonsillectomy using the hot technique. Post-tonsillectomy haemorrhage occured in 46 (4.23%) patients. 45 (4.88%) patients had a postoperative haemorrhage after tonsillectomy using the combined technique, whereas haemorrhage occured in 1 patient (0.6%) after using the hot technique. The haemorrhage rate was about eight times lower after tonsillectomy using the hot technique (p=0.012). Conclusion: We conclude that the surgical technique used for tonsillectomy and adenotonsillectomy with the lowest post-tonsillectomy haemorrhage rate is the hot technique; these results are statistically significant. This technique should be used whenever possible, in order to lower the risk of post-tonsillectomy haemorrhage.

Introduction: Serum uric acid (SUA) is the final product of purine metabolism in humans. Aim: The present study aimed to identify a potential association between serum UA and cardiac troponin I (cTnI) levels and to find out whether uric acid could differentiate patients presenting with the acute myocardial infarction (AMI) and unstable angina pectoris (UAP) in hyperuricemic and normouricemic acute coronary syndrome (ACS) patients. Methods: Eighty ACS patients, aged 50-83 years, were enrolled in the study, 40 of them presenting with AMI and 40 with UAP. Frequency of patients with serum uric level over threshold for hyperuricemia was investigated and two groups of patients were formed such as hyperuricemic and normouricemic groups (A and B groups, respectively) independently of type of ACS. Those groups of patients were also subjected to cTnI measurement. Results: Levels of SUA are associated with the type of ACS in the hyperuricemic ACS patients (AMI versus UAP, 499(458-590), 425(400-447) mmol/L, p=0.007, respectively). Uric acid correlated significantly with cTnI, moderate positively in the group A (rho=0.358, p=0.038) and moderate negatively in the group B (r=-0.309, p=0.037) of ACS patients. Multiple logistic regression analysis revealed that cTnI and age were independently associated with the SUA levels in the group A of ACS patients. Conclusions: Serum uric acid differentiates AIM and UAP patients in hyperuricemic group of acute coronary syndrome. Therefore it can be used as nonspecific parameter for evaluation of the myocardial lesion extent only in hyperuricemic ACS patients. This is supported by finding that cTnI along with age predicts SUA level in hyperuricemic ACS patients.

1Travnik General Hospital, Travnik, Bosnia and Herzegovina 2Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina KeYWORdS: patent foramen ovale, management. citAtiON: Cardiol Croat. 2019;14(3-4):92-3. | https://doi.org/10.15836/ccar2019.92 *AddReSS FOR cORReSPONdeNce: Alma Sijamija, J.U. Bolnica Travnik, Kalibunar bb, 72270 Travnik, Bosna and Herzegovina. / Phone: +387-61-780-085 / E-mail: alma.sijamija@hotmail.com ORcid: Alma Sijamija, http://orcid.org/0000-0003-2818-0501 • Nermir Granov, http://orcid.org/0000-0002-6228-6230 Alma Agačević, http://orcid.org/0000-0003-4671-0991 • Omer Perva, http://orcid.org/0000-0003-2645-1558 Nedžad Hadžić, http://orcid.org/0000-0002-7186-7803

ABSTRACT Emergency contraception (EC) in Serbia is available in two products: Levonorgestel, which has nonprescription status, and Ulipristal acetate, which is a prescription-only medicine. Considering their dispensing statuses, gynecologists and pharmacists are health care professionals (HCPs) with the widest impact on EC use. Yet little is known about their beliefs and practices regarding these medicines. We surveyed 166 gynecologists (during October 2012—October 2013) and 452 community pharmacists (during January–April 2014). Results showed significant differences between these two groups, suggesting that provision of EC to users may be inconsistent. Gynecologists were more convinced than pharmacists that EC would reduce the abortion rate (86% versus 53%, p < .001). However, they were more concerned than pharmacists that easy access to EC would cause less regular contraceptive use (66% versus 29%, p < .001) and risky sexual behaviors, including initiating sexual activity at a younger age (37% versus 19%, p < .001) and having more sexual partners (33% versus 12%, p < .001). Additionally, more pharmacists than gynecologists (12% versus 2%, p < .001) said they would not provide EC to anyone under any circumstance, even to victims of sexual assault. These results indicated a need for reevaluating and establishing official guidelines for dispensing practices.