Introduction Clozapine is a drug that can cause several side effects. Among the less commonly described is a drug-induced lung disease. Due to its non-specific clinical presentation, it represents a diagnostic challenge. The diagnosis is made based on: 1. Association of exposure to the agent and development of symptoms, 2. Pulmonary infiltration, 3. Exclusion of other causes, 4. Withdrawal of symptoms when the agent is excluded from therapy. To date, there have been only a few descriptions of this condition. Objectives Case report of rare side effect of clozapine. Methods Case report Results Case report: male patient (37) with schizophrenia, was hospitalized after a brutal suicide attempt. The PCR test for COVID-19 that was routinely performed on admission was negative. After the introduction of clozapine into therapy, the patient became febrile. There was a drop in oxygen saturation, a Lung CT scan showed inflammatory changes („ground-glass opacities“), and COVID-19 pneumonia was suspected. Due to the worsening of the mental state, the dose of clozapine was increased. The physical condition further deteriorated: febrile, sO2 declining. After repeated PCR tests for COVID-19 (all negative), interstitial pneumonia caused by clozapine was suspected, and clozapine was excluded from therapy. The physical condition started to improve. Quetiapine was introduced, and occasional episodes of agitation were relieved with intramuscular diazepam. In the following days, the patient’s mental state improved and he was discharged. Conclusions Despite its superiority over other antipsychotics, clozapine was with good rationale ranked third in treatment guidelines for schizophrenia. Disclosure No significant relationships.

Background: The Brixia scoring system interpreted chest X-ray changes, serves as an indicator of the extent of changes in the lung parenchyma Objective: To indicate the effect of D-dimer and C-reactive protein (CRP) on Brixia score in patients with positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: The research had prospective, descriptive and analytical character, and included patients (n=104) with Coronavirus disease 2019 (COVID-19) diagnosis. Chest X-ray, as well as calculation of Brixia score was done on admission, in the first week of hospitalization, on discharge, and 10 days after discharge (the patient was considered a post-COVID patient. Maximum CRP and D-dimer values were taken into account, along with data about dependence of mechanical ventilation and oxygen therapy. Results: Initial Brixia score was significantly associated with the values of CRP (r = .23, p <.05). Higher level of CRP affected the higher result on the Brixia score after the initial X-ray. High CRP and D-dimer were significantly associated with oxygen use in patients, while high D-dimer was also statistically significantly associated with comorbidity. The mean value of Brixia score (during four time points) was significantly related to the values of CRP, D-dimer, the use of mechanical ventilation and oxygen therapy, but also with the existence of comorbidities. The largest statistically significant positive correlation of Brixia scora is with the values of D-dimer (r = .45, p <.000), but also with the values of CRP (r = .36, p <.000). Conclusion: Values of CRP have an impact on Brixia score. Investigation of clinical characteristics and outcomes of severe clinical presentation of COVID-19 along with CXR scoring system will contribute to early prediction, accurate diagnosis and treatment as well as to improve the prognosis of patients with severe illness.

BACKGROUND Deep vein thrombosis (DVT) can be symptomatic or asymptomatic in patients with acute pulmonary embolism (PE). The prognostic value of the symptomatic DVT at the presentation regarding the prognosis of PE is unknown. METHODS Data were extracted from the REgional Pulmonary Embolism Registry (REPER) which enrolled 1604 hospitalized patients after multidetector computed tomography (MDCT) diagnosed symptomatic acute PE. According to the ESC risk model, patients were classified into four subgroups. Patients who had leg edema with or without pain, and patients with leg pain and DVT confirmed by compression ultrasound were considered to have symptomatic DVT. This study aims to compare all-cause hospital mortality between patients with symptomatic DVT and patients without symptoms or signs of DVT across the PE risk stratums. RESULTS All-cause mortality in patients with symptomatic DVT compared to those who had no signs or symptoms of DVT were 2/196 (1.0%) vs 11/316 (3.5%), p=0.145, 4/129 (3.1%) vs 17/228 (7.5%), p=0.106, 14/196 (7.1%) vs 54/290 (18.6%), p<0.001 and 16/55 (29.1%) vs 51/139 (36.7%), p=0.402 in patients with low, intermediate-low, intermediate-high and high-risk PE, respectively. In multivariate analysis symptomatic DVT was associated with decreased inhospital mortality only in patients with intermediate-high PE (OR 0.320, 95%CI 0.164-0.627; p=0.001). Intermediate-high risk PE patients with symptomatic DVT who were treated with thrombolysis had significantly lower hospital mortality than patients without signs or symptoms of DVT (2.2% vs. 11.4%, p=0.003). CONCLUSIONS Intermediate-high risk PE patients with symptomatic DVT at presentation may benefit from thrombolysis and have lower hospital all-cause mortality in such circumstances.

Introduction: Neck pain (NP) may have a local mechanical (non-specific) origin caused by dysfunction of the joint, muscle, and ligament structures in the neck or by a discogenic etiology. Most people (50–60%) suffer from NP at some point in their lives. They are more common in highly developed countries and in urban areas. The aim of this study is to determine the prevalence of NP and its impact on daily living activities in the student population. Methods: The study included students of the University of Sarajevo - Faculty of Health Studies in the period from May 2021 to June 2021. The sample of respondents was formed by the method of random selection and included respondents of both sexes, aged 19–28 years. The study was conducted as a transversal cross-sectional study at a specific time point on the frequency of NP and the ability to perform activities of daily living in the student population. Results: Out of the total number of 255 respondents, 77 (30.2%) reported that they have NP while 178 (69.8%) respondents reported that they do not feel NP and it was found that there was no statistically significant difference between the age groups of the subjects with and without NP. The study concluded that a higher percentage of respondents with NP did not engage in leisure activities and that respondents with NP had lower mobility in daily life, sleep disturbance, and poorer ability to perform activities of daily living due to NP. Conclusion: The study conducted revealed that a significant percentage of the student population with NP has a lower ability to perform activities of daily living. Considering the above facts and the current transformation of the educational model, in which static postures dominate, it is necessary to design and implement programs for targeted physical activity and prevention of long-term inactivity that leads to painful musculoskeletal syndromes.

Introduction Hyperprolactinemia is a common unwanted antipsychotic-induced adverse effect, particularly in female patients, and can induce poor adherence to treatment. Aripiprazole is an antipsychotic with partial agonist activity over the dopamine D2 receptors which can be effective in reducing hyperprolactinemia in patients treated with antipsychotics. Objectives We investigate the efficacy of adjunctive treatment with aripiprazole for olanzapine-induced hyperprolactinemia and related hormonal side effects (amenorrhea, oligomenorrhea) in female patients with schizophrenia. Methods Eight female patients (22 to 40 years old) participated in this study with a diagnosis of schizophrenia and hyperprolactinemia-related hormonal side effects (amenorrhea, oligomenorrhea). Patients were treated with aripiprazole 10 mg/day added to a fixed olanzapine dose of 20 mg/day. Serum prolactin levels were measured at baseline and after 2, 4, 6, and 8 weeks. Symptoms and side effects were assessed using the Brief Psychiatric Rating Scale, Clinical Global Impressions Severity scale, Barnes Akathisia Scale. Results Adjunctive treatment with aripiprazole resulted in significantly lower prolactin levels beginning at week 2. 87.5 % of patients at week 8 had prolactin levels normalize. Among 8 patients with menstrual disturbances, 75% of patients regained menstruation during the study. No significant changes were observed regarding psychopathology and adverse effect ratings. Conclusions Adjunctive aripiprazole treatment is effective for resolving olanzapine-induced hyperprolactinemia and reinstatement of menstruation in female patients, provides significant improvement and it appears to be safe with a lower risk of metabolic syndrome, without increased risk of adverse effects. Disclosure No significant relationships.

Abstract This paper presents the findings of a study on digital maturity in higher education institutions in Bosnia and Herzegovina (BiH). Empirical research was conducted in 2020. Teachers from eight public higher education institutions in Bosnia and Herzegovina were included in the sample. The findings revealed that digital transformation has been ongoing in these institutions for some time, that some results have been achieved, but that digital maturity has not yet been attained. The findings also revealed barriers that must be overcome in order to accelerate digitalization and reap the anticipated benefits.

Field maple (Acer campestre L.) is naturally distributed in most of Europe, with the exception of its northern parts. Field maple can serve as a valuable model for researching the sensitivity of its populations to habitat fragmentation, considering lack of silvicultural treatments in its stands. The research aims to determine interpopulation and intrapopulation variability of field maple populations from Bosnia and Herzegovina in the nursery test. The authors researched measured root collar diameter, height, observed forkness and calculated slenderness coefficient of the one-year-old generative material from 18 Bosnian-Herzegovinian populations of field maple, produced in the nursery of Žepče. The descriptive statistics and variance analysis was performed. All analyzed traits showed a high degree of intra-population as well as interpopulation variability, as confirmed by the analysis of variance. The highest average height had provenance Bosanski Brod (46.08 cm) and the smallest Bosanska Dubica (19.11 cm). Kreševo provenance had the highest average root neck diameter (8.27 mm) and Bosanska Dubica (5.24 mm) the lowest. A very low percentage of forkness (6.86%) was determined, and the values of the slenderness coefficient were acceptable for all provenances. The results indicate need for further systematic research on this ecologically valuable species.

Using recent advancements in high-performance computing data assimilation to combine satellite InSAR data with numerical models, the prolonged unrest of the Sierra Negra volcano in the Galápagos was tracked to provide a fortuitous, but successful, forecast 5 months in advance of the 26 June 2018 eruption. Subsequent numerical simulations reveal that the evolution of the stress state in the host rock surrounding the Sierra Negra magma system likely controlled eruption timing. While changes in magma reservoir pressure remained modest (<15 MPa), modeled widespread Mohr-Coulomb failure is coincident with the timing of the 26 June 2018 moment magnitude 5.4 earthquake and subsequent eruption. Coulomb stress transfer models suggest that the faulting event triggered the 2018 eruption by encouraging tensile failure along the northern portion of the caldera. These findings provide a critical framework for understanding Sierra Negra’s eruption cycles and evaluating the potential and timing of future eruptions.

Although fluorides are essential for dental health, there are growing health concerns regarding the risk-benefit ratio of fluoride exposure. The objectives of the study were to obtain data on the amount and human health risks of fluoride in drinking groundwater, as well as to compare and evaluate the differences in the outputs obtained by two different approaches in health risk assessment (deterministic vs probabilistic). From a densely populated industrial area of northeastern Bosnia and Herzegovina, a total of 54 groundwater samples were collected. Fluoride concentrations varied from 1.69 to 3.52 mg/L. The WHO’s threshold value for fluoride in drinking water was exceeded in all the samples analysed, indicating an increased daily intake of fluoride from groundwater. Deterministic and semi-probabilistic techniques were used for exposure assessment and health risk quantification. Generally, the deterministic approach resulted in acceptable health risks in most adult exposure scenarios. However, the Monte Carlo simulation revealed that 20.6, 20.8, and 99.8% of adult males, females, and children, respectively, were above the tolerable upper intake level, indicating that both adults and children face a significant health risk. Nevertheless, small children are more vulnerable to environmental hazards than youth and adults. Hence, a more in-depth risk-benefit analysis is required to reduce/or optimize fluoride content in drinking water to prevent tooth decay and fluorosis at all ages. Considering that optimal daily intake of fluorides is a crucial factor for preserving human health, decision-makers should take steps to emphasize the importance of continuous monitoring of fluoride concentrations in drinking water.

Background: Nowadays, most women of reproductive age utilize various methods of contraception to avoid undesired pregnancy and regulate menstrual cycles. Objective: The aim of this study is to evaluate current sexual patterns, menstrual health status and use of contraceptive methods in reproductive aged females in Bosnia and Herzegovina during the COVID-19 pandemic. Methods: This cross-sectional study was conducted in the period between February 21st and March 5th 2022 via an online anonymous questionnaire which was distributed using social media platforms. Results: Menstrual periods were normally regular in 269 (85.7 %) of the females, whereas 45 (14.3 %) experienced irregular menstrual cycles. Females report having either one sexual partner 149 (47.5%) or no sexual partners 76 (24.2%) and typically no 92 (29.3%) or frequent (more than 8 sexual intercourses) sexual intercourses per month. The usage of contraceptive methods was reported among the majority 212 (67.5%) and mostly by using of male condom 104 (33.1%), followed by the withdrawal method 64 (20.4%), oral contraceptive pills 35 (11.1%), emergency contraceptive pills “after 24h” 2 (0.6%) and intrauterine device 7 (2.2%). The usage of contraceptive methods was higher among younger females (X2=18.07, p<0.001) and among those who were employed (X2=10.86, p<0.001). Those who used oral contraceptive pills used mostly pills that are combination of progesterone and oestrogen 32 (91.4%) and for the purpose of regulation of menstrual cycles 26 (74.2%) and to prevent unwanted pregnancies 9 (25.8%). Females who had no sexual intercourses per month (OR+0.27, 95% CI 0.09-0.79, p=0.018) were less likely, while those who had irregular menstrual cycles (OR=2.44, 95% CI 1.04-5.71, p=0.039) were more prone to use oral contraceptive pills. Conclusion: Bosnia and Herzegovina reproductive aged female had relatively regular menstrual cycles, the majority used modern contraceptive methods to prevent unwanted pregnancies or for the regulation of menstrual cycles during the COVID-19 pandemic.

Background: COVID-19 has different presentations from mild flu like symptoms such as anosmia, dysgeusia, fever, sore throat, cough, dyspnea, headache, abdominal pain and diarrhoea to severe COVID-19 with the development of acute respiratory syndrome (ARDS), septic shock, metabolic acidosis, coagulation dysfunction, multiorgan failure or even death. Objective: The aim of this research project was to present and highlight the outcomes of the vaccination against COVID-19 and the widespread use of antibiotics during the initial admission and treatment of COVID-19 patients in out of hospital settings. Methods: This observational cross-sectional study was conducted between September 1st and September 24th 2021, during the fourth wave of COVID-19 outbreak in Bosnia and Herzegovina, among the patients admitted to the primary health care COVID-19 centre of Canton Sarajevo in Bosnia and Herzegovina. Results: Patients were mostly female 213 (53.3%), with a mean age of 48.8±18.6, with hypertension 129 (32.3%) or diabetes mellitus 35 (8.7%) as comorbidities and being COVID-19 unvaccinated 236 (59.0%) COVID-19 unvaccinated patients expressed more fever (X2=9.93, p<0.05), had typical COVID-19 chest X ray presentation (X2=6.08, p<0.05) and abnormal lung auscultation sounds (X2=5.43, p<0.05). Out of all patients, 312 (78.0%) have received antibiotics and 3 (0.75%) antivirotics such as favipiravir as therapy for the treatment of COVID-19. The mean duration of the antibiotic regime was 10.2 ± 7.5 days with a minimum of 3 days and maximum of 62 days. The minimum CRP value when antibiotics were prescribed was 0.1 (ref. value <5mg/l). The most prescribed antibiotic was doxycycline 172 (43.0%), followed by ceftriaxone 139 (34.7%) and azithromycin 108 (27.0%). Conclusion: Our study showed that vaccination acts protective for the development of severe COVID-19 forms, as well as that antibiotics were overused among COVID-19 infected. The outcome of such malpractice could lead to antimicrobial resistance which will be seen in further years. Governmental agencies should advise physicians to change these trends.

Abstract Background: Owing to the heaviness of setbacks and shocks companies frequently face from the internal/external business environment, building solid organizational resilience and shifting towards strategic sustainability have become the top demands in today’s wavering business world. Objectives: This study aimed to determine whether strategic sustainability orientation influences organizational resilience and how this relationship is moderated by firm size. Methods/Approach: This study uses a methodology structured around the stakeholder theory and embraces multiple regression analysis grounded on collected data from 124 enterprises in Bosnia and Herzegovina ambience. Results: Findings from the research revealed that strategic sustainability orientation significantly and positively influences organizational resilience and its three sub-components: anticipation, coping and adaptation capabilities. Results also uncovered that the Small size firms were significantly diverse from the Large and Medium size firms in terms of the influence of strategic sustainability orientation on three capabilities of organizational resilience. Conclusions: In addition to literature enriching in sustainability and organization by supplying empirical evidence of strategic sustainability orientation influence on organizational resilience, this study proposes and validates instruments for measuring strategic sustainability orientation and organizational resilience.

Abstract The Logistics Performance Index (LPI) performed by the World Bank is an indicator of the logistics environment quality of a country in which logistics operators act. The LPI is an interactive tool designed to help countries identify challenges, innovative solutions, and opportunities they face in their work in the field of trade and logistics. The aim of this paper is to conduct a comparative analysis and ranking of the LPI of the countries in the Western Balkans (Bosnia and Herzegovina, North Macedonia, Albania, Serbia and Montenegro), calculated by the World Bank for 2018, using an integrated Criteria Importance Through Intercriteria Correlation (CRITIC)-Measurement Alternatives and Ranking according to Compromise Solution (MARCOS) model and thus show the real picture of the logistics environment. In order to determine the performance of countries and show the overall logistics performance, six key dimensions are used: customs, infrastructure, international transport, logistics capability, tracking and tracing of goods and shipment delivery within scheduled or expected times. Using the CRITIC method, the weight values of the previously mentioned six criteria were calculated, whereby the criterion related to shipment delivery within scheduled times was singled out as the most significant criterion. Then, by applying the MARCOS method, the countries of the Western Balkans were ranked on the basis of the six defined criteria. Based on the results obtained, the best-ranked country is Serbia. The analysis of the sensitivity of the results to changes in the significance of the criteria does not show significant changes in the ranking.