Introduction: The treatment response and outcome in acute myeloid leukaemia (AML) is heterogeneous. Aim: To analyze the prognostic parameters of AML at presentation. Methods: The total sample of 44 AML patients was analyzed on the basis of age <55 and ≥55 years, sex, WBC count <50x10/9/l and ≥50x10/9/l, the Hb concentration <100 g/l and ≥100 g/l, PLT count <100x10/9/l and ≥100x10/9/l, Karnofsky score <60% and >60%, cytogenetics, CD56 expression, morphological type and types of treatment (standard and reduced induction chemotherapy, high–dose chemotherapy/stem cell transplantation – autologous and HLA matched, related, allogeneic, together and separately). Results: The age <55 years, Karnofsky score >60% and standard induction chemotherapy statistically correlated with the higher complete remission (CR) rates, longer relapse free survival (RFS), lower relapse rate (RR), and longer overall survival (OS) (p<0.01). The difference in terms of CR and RR between the sexes were not statistically significant (p<0.05), however women had statistically lower OS comparing to men (9.71±4.54 months vs. 38.03±9.17 months) (p<0.01). WBC count ≥ 50x10/9/l and the Hb concentration <100 g/l statistically correlated with shorter OS (p<0.05), while the WBC count ≥50x10/9/l statistically correlated with shorter RFS (p<0.05). The PLT count <100x10/9/l and ≥100x10/9/l was not found as prognostically significant for CR, RR, RFS, and OS (p<0.05). In comparison to the standard induction chemotherapy, both types of high dose chemotherapy/stem cell transplantation (HDT/SCT) (10/22), together and separately, resulted in longer RFS, lower RR, and longer OS (p<0.05). The frequency of cytogenetic risk was intermediate 81.6%, unfavorable 13.2%, and favorable 5.3%, respectively. CD56 + expression statistically correlated with the lower PLT count, higher RR, shorter RFS, and shorter OS (p<0.05). Statistical analysis of the cytogenetic risk and morphological types of AML were not possible due to the small number of patients in stratified groups. Conclusions: Female sex, the WBC count >50x10/9/l, the concentration of Hb <100 g/l, and CD56 + expression, at presentation of AML, should be considered as parameters of adverse risk, especially in latter decisions considering post-remission treatment with HDT/SCT.

Aim To compare intubation conditions and hemodynamic response of two induction regimens, with or without muscle relaxant using a combination of either fentanyl and propofol or propofol and suxamethonium. Methods A total of 80 children aged 4-12 years were enrolled in a prospective randomized double-blinded study. Children were randomly allocated in two equal groups. In group F induction was done with fentanyl and propofol, while propofol and suxamethonium were used in group S. Intubation conditions were assessed using Copenhagen Consensus Score (CCS), based on ease of laryngoscopy, position of vocal cords, degree of coughing, jaw relaxation and limb movements. Systolic blood pressure (SBP),diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were observed at preinduction, postinduction and postintubation at 1, 3 and 5 minute. Results Clinically acceptable CCS was found in 95% of patients in group F versus 100% in group S. Intubation conditions wereexcellent in 85%, good in 10% and poor in 5% of patients in group F. In the group F, signifficantly lower SBP and MAP postinduction and postintubation at 1 and 3 minute, and lower DBP postinduction and postintubation at 1 minute (p<0.05) was found comparing to group S. In group S, significantly higher postinduction and postintubation HR at 1 minute was found comparing to group F (p<0.05). Conclusion Induction combination fentanyl-propofol provide acceptable intubation conditions comparable with suxamethonium in children. This induction regimen ensures better hemodynamic stability associated with endotracheal intubation. It could be recommended for intubation when muscle relaxants are not indicated.

Aim To define direct anatomical relations of the sphenoidal (alae minores), ethmoidal sinuses and optic nerve, with an emphasis on determining the effect of age on pneumatisation and dehiscence. Methods This retrospective, descriptive study involved 60 consecutive patients: 30 patients younger than 30 and30 patients older than 60 years of age. All patients underwent computerized tomography(CT). The relationship of the optic nerve and the sphenoidal and ethmoidal sinuses was classified. The presence of dehiscence in the bone structures, forming the optic canal, was checked. Dehiscence was defined as absence of visible bone density located between the sinus and the optic nerve. Protrusion of the optic nerve into the sphenoidal sinus was defined as optic nerve surrounded by pneumatised space. Results The most common type of relation between the optic nerve and sphenoidal sinus was type I, where the optic nerve was immediately adjacent to the lateral or superior wall of the sphenoidal sinus, without impression on the sinus wall. Dehiscence was documented in 15 (25%) cases, it was more common in older patients (8, 27%) than in younger ones (7, 23%). The pneumatisation processes were more frequent in patients over 60 (5, 17%) than in those younger than 30 years (4, 13%). Conclusion Surgeons and ophthalmologists should be aware of high frequency of dehiscence of sphenoidal sinus walls when treating adult patients in our population, especially when evaluating risks and complications of surgical procedures or when diagnosing inflammatory or tumorous processes in the close vicinity of posterior paranasal sinuses.

Aim To investigate the relationship between recovered hepatitis B infection with appearance of toxic propylthiouracil (PTU) hepatitis and point out the growing importance of the use of drugs in the development of hepatitis. Methods A case of a 45-year-old female patient with suspicion of acute viral hepatitis who had polypragmasy of drugs in the last ten years, due to the polymorphism of symptoms/illnesses (diabetes mellitus, depression, hypertension, hypothyroidism) was presented. Results A female patient had hyperthyroidism after resolved viral hepatitis B with HBsAg seroconversion (HBsAg negative, antiHBs positive). PTU had the greatest potential for hepatotoxicity of all administered drugs. After corticosteroid therapy there was a significant improvement in liver function tests. In the course of the disease there was no change of hepatitis markers and exacerbations of hepatitis B. Conclusion Clinical practice should comprehensively monitor the effects of the intricate and tight connection between drugs, liver and endocrine system in order to better resolve all manifestations, complications and worsening of one or another organic system.

Background: According to the UNHCR, 250 million people currently live outside their country of birth. The growing multicultural population poses a major challenge to healthcare professionals who aim to provide individualized, holistic care, which respects the individual’s autonomy. To ensure basic rights, healthcare interventions should be guided by the value of benefiting others; individuals should be treated honestly, equally, and impartially. Objective: To investigate immigrant doctors’ experiences of using interpreters in the Swedish health-care system. Material and Methods: Twenty-eight doctors, 12 men and 16 women from Bosnia and Herzegovina, Croatia, Macedonia and Serbia participated in four focus group interviews (FGI). The interviews were audio recorded, transcribed and analyzed using content analysis method. Results: The best results in the present study were achieved in situations where a professional interpreter was involved. In some cases, the doctors were forced to use relatives or a colleague to interpret, which in many cases proved to be a mistake. The consequences of poor interpretation routines included payment by mistake, a patient paying an interpreter who refused to interpret, time spent waiting for another interpreter, as well as disturbances to the daily work schedule. Finding someone who could replace an interpreter who did not show up caused time shortage and increased stress. Conclusions: Improved routines and more effective cooperation between interpreting services and health-care centers are needed in order to ensure that using professional interpreters guarantees appropriate, high quality care. Improvements are needed to provide satisfactory health-care to people with limited language skills. In order to achieve this, better education of interpreters is needed, especially regarding cultural diversity and medical terminology. These improvements present complex challenges, deserving empirical and critical reflection in order to improve the work situation for doctors.

Cough is one of the most common symptoms that doctor faces in working with pediatric population, and according to some characteristics of cough, doctors can often conclude localization, and sometimes even the nature of the disease that causes it. Cough is not only the physiological defense reaction, but a symptom of a disease. According to duration it can be acute, chronic and recidivist, recurrent and persistent, strong or discreet, caused by changes in body position and changes in outside temperature. Pathoanatomically it is divided into lobar, lobular, alveolar and interstitial, pathogenetically to bronchogenic and hematogenous, as well as in immuno competent and immunocompromised, and clinically on the local and inpatient (72 hours after hospital admission). Considering the contents, cough can be productive–with secretion from the respiratory tract, and unproductive-dry, without secretion. By auscultation bronchial breathing, rattle and crepitus can be heard. The primary diagnostics is radiological, posterior to anterior (P-A) and lateral footage of the chest. Laboratory findings in typical pneumonia, are characterized by leukocytosis, neutrophilia and shift of blood image to the left. Sedimentation is accelerated and C-reactive protein is elevated. The basic bacteriological diagnosis is sputum Gram’s stain and culture of sputum. In atypical pneumonia, leukocytes are usually in the normal range, and it is necessary to do serological tests (IgM and IgG antibodies). The role of doctors in primary health care is auscultation differentiation of murmurs with confirmation of doubt if there is pathological findings by laboratory tests and treatment, depending on the type of cough. Treatment is essentially pharmacological, with irrefutable importance of non-pharmacological measures.

Aim To investigate and assess knowledge and attitudes of pharmacists and physicians towards generic drugs prescription in order to evaluate current trends, obstacles to prescribe/dispense generics and suggest possible improvements of rational and economic prescribing having in mind scarce public budgets for drugs. Methods A cross-sectional survey among 450 primary care physicians (prescribers) and pharmacists in four major cities in Bosnia and Herzegovina (Sarajevo, Banja Luka, Tuzla and Mostar) during the period between January and March 2016 was conducted. The survey (questionnaire) was developed and physicians' and pharmacists' perception was examined using the 5-point Likert scale. Descriptive statistics was used to examine respondents' characteristics and their responses to survey questions. The respondents perception based on different characteristics was assessed using ordinal logistic regression. Results Generally, positive attitudes towards generic drugs were found. Majority of respondents, 392 (87.0%) considered generic drugs the same as originators and they could be mutually substituted. Physicians were more likely to prescribe branded drugs, 297 (66.6%), even 391 (86.8%) were aware of generic alternatives. Respondents believed that patients considered generic drugs less effective, 204 (45.4%), and 221 (49.0%) disapproved generic substitution. Conclusion Our findings suggest that further education and more information about benefits of generic drugs should be provided to key stakeholders including patients. Also, clearer generic drugs policies should be introduced in order to improve generic prescribing and potentially improve access and optimize pharmaceutical public expenditures.

Scots pine (Pinus sylvestris L.) and European beech (Fagus sylvatica L.) dominate many of the European forest stands. Also, mixtures of European beech and Scots pine more or less occur over all European countries, but have been scarcely investigated. The area occupied by each species is of high relevance, especially for growth evaluation and comparison of different species in mixed and monospecific stands. Thus, we studied different methods to describe species proportions and their definition as proportion by area. 25 triplets consisting of mixed and monospecific stands were established across Europe ranging from Lithuania to Spain in northern to southern direction and from Bulgaria to Belgium in eastern to western direction. On stand level, the conclusive method for estimating the species proportion as a fraction of the stand area relates the observed density (tree number or basal area) to its potential. This stand-level estimation makes use of the potential from comparable neighboring monospecific stands or from maximum density lines derived from other data, e.g. forest inventories or permanent observations plots. At tree level, the fraction of the stand area occupied by a species can be derived from the proportions of their crown projection area or of their leaf area. The estimates of the potentials obtained from neighboring monospecific stands, especially in older stands, were poorer than those from the maximum density line depending on the Martonne aridity index. Therefore, the stand-level method in combination with the Martonne aridity index for potential densities can be highly recommended. The species’ proportions estimated with this method are best approximated by the proportions of the species’ leaf areas. In forest practice, the most commonly applied method is an ocular estimation of the proportions by crown projection area. Even though the proportions of pine were calculated here by measuring crown projection areas in the field, we found this method to underestimate the proportion by 25% compared to the stand-level approach.

Aim To determine the prevalence of hepatitis C virus infection (HCV) among prisoners in Zenica prison, and to investigate the relation between HCV and risky behaviors: intravenous drugs use (IDU), tattooing, promiscuity. Methods This cross-sectional study conducted at the High Security Penitentiary in Zenica involved 200 convicted persons who gave their consents for the research. Their blood was tested by AraGen Hepatitis C Test. Risky behaviors (IDU, tattooing, promiscuity) were tested by an anonymous self-administered questionnaire. Results The prevalence of HCV was 13% (26/200). There was a statistically significant correlation of HCV infection and drug abuse before imprisonment (p=0.00), injection drug abuse before imprisonment (p=0.00), tattooing in prison (p=0.03) and having sex with homosexual partners (p=0.00). Conclusion The prevalence of HCV in prisoners at Zenica prison was significantly higher than in the general Bosnia and Herzegovina population. Intravenous drugs use had highest risk for HCV infection among prisoners.