Functional appliances are key to success in early orthodontic therapy. Their application is most useful in the period of a pre-puberty and pubertal growth spurt, in order to achieve facial aesthetics and improve the patient's health. The aim of treatment with functional appliances is to act on the muscles and ligaments, thereby influencing the movement and growth of the lower jaw forward, when it comes to the distal bite. The devices are used to correct malocclusions in all three spatial planes: sagittal, vertical, and transferal. In the sagittal dimension, the distal bite is corrected and Angle class I occlusion is established. In the transferal dimension, appliances are used to expand the dental arches. In the vertical dimension, appliances are used to correct an open or deep bite. Most often, mobile functional appliances are used, which consist of special upper and lower parts, such as the Twin block and the "M" block. Other types of functional devices have been used for many years, they consist of one part and their disadvantage is discomfort for patients and the impossibility of use in the presence of septal deviation or any other airway obstruction (activator and all its modifications, as well as Bionator). Recently, fixed functional appliances are also used, the advantage of which is that they do not depend on the cooperation of the patient and that they hold the mandible in an anterior position for 24 hours, achieved on the basis of an adequately taken construction bite. Their application is not conditioned by the puberty growth spurt but can be used by post-adolescents and young adults. In the production of functional appliances, the most important thing is to take a good construction bite, which determines how the muscle power will be transferred to the tissues, teeth, and jawbone. They determine the course of treatment and its duration. Muscle activation is performed in sagittal, transverse, and vertical directions, individually for each patient depending on the type of device.

Background: Increasing evidence indicates that COVID-19 may result in cardiac issues in certain individuals, such as myocarditis, arrhythmias, and heart failure. Ongoing research on echocardiographic manifestations is still limited. Objective: To investigate the incidence and patterns of left and right ventricular dysfunction in COVID-19 patients. Methods: This study retrospectively observed COVID-19 patients admitted to the Clinical Center of University of Sarajevo during the third wave, with a particular focus on cardiac evaluations. Results. Our patients, predominantely male 155 (72.4%), with a mean age of 66.2±11.4, having hypertension 86 (40.1%), diabetes mellitus 61 (28.5%), hyperlipidemia 144 (67.3%), were active smokers 87 (40.6%), had family history of cardiovascular diseases 123 (57.5%) and were COVID-19 positive 95 (44.4%), presented because of chest pain 78 (36.4%), dyspnea 103 (48.1%), palpitations 67 (31.3%), fatigue 106 (49.5%) and peripheral oedema 30 (14.0%). COVID-19 patients reported much higher symptoms of dyspnea (65 (68.4%) vs 38 (31.9%)) and fatigue (73 (76.8%) vs 33 (27.7%)) than COVID-19 negative patients. On the initial laboratory report, COVID-19 patients had a significantly (p<0.05) higher mean score of C-reactive protein (24.0±4.8 vs. 6.0±2.1), D-dimer (1.6±2.5 vs 0.8±0.6), ALT (94.8±17.2 vs 36.5±19.9) and creatinine (128.0±80.8 vs. 93.4±40.1) when compared to COVID-19 negative patients. COVID-19 patients had enlarged left atrium diametes (31.6±5.6 vs 27.5±5.3), enlarged left ventricular diameter both in systole (27.9±18.1 vs 23.3±16.3) and diastole (39.3±24.1 vs 34.9±22.7), reduced left ventricular ejection fraction (53.5±9.2 vs 59.8±4.3) and elevated right ventricular systolic pressure (37.0±16.4 vs 35.1±8.6). Conclusion. COVID-19 patients had enlarged left atrium, enlarged systolic and diastolic left ventricular diameter, reduced left ventricular ejection fraction and elevated right ventricular systolic pressure.

Background: The development of medicine and pharmacy in the Bosnia and Herzegovina was marked by different historical periods–first they were settled by the Illyrians and Delmatians, and after them came the Romans, the Ottoman Empire and the Austro-Hungarian Monarchy. Objective: The aims of this article are to show, based on the available literature: a) The development of medicine and pharmacy in Bosnia and Herzegovina from the medieval period until the Second World War; b) The most significant historical events that marked the development of medicine and pharmacy in the areas of Bosnia and Herzegovina; c) Methods of treatment, medicinal forms and preparations that were used in the mentioned period. Methods: The subject of this study was the development of medicine and pharmacy in the areas of Bosnia and Herzegovina from the 14th century until the Second World War. In order to achieve the set goals, a) Retreival of professional and scientific literature and b) Search of scientific databases and web pages on the Internet that offer adequate and relevant data and historical facts related to the subject of studies were carried out. Most of the facts are covered in previously published articles by the author and deposited in the PubMed and PubMed Central databases, as well as in books and monographs by the author of this text. Results and Discussion: In the Middle Ages, folk medicine was present, in which herbalists looked for medicines in certain plant and animal species. In the 13th century, Bosnia was settled by the Franciscans, who permanently marked the development of medicine and pharmacy. They are educated at prestigious universities abroad, from where they bring their knowledge, skills and recipes and write them in books, which are called ljekaruse (medicine books). Every historical period brought some changes for medicine and pharmacy, so the Ottoman Empire brought customs of frequent cleaning, public fountains and hammams were built. During the reign of the Austro-Hungarian Monarchy, the first hospitals and pharmacies were established, and laws on pharmacy activity were introduced. Written documents on the history of the medicine and pharmacy development in Bosnia and Herzegovina are mostly found in the libraries of monasteries, and a significant number of them are also in the libraries of madrasas, and the National and University Librarie in Sarajevo and the library of former Institute of Hygiene in Sarajevo. Conclusion: In connection with the medical and pharmacy practice of the Bosnian Franciscans, the question of the various medical records that they created, which helped them in their health efforts, stands out. First of all, we are talking about numerous medicinal books, so called ”ljekaruse”. On the soil of Bosnia and Herzegovina, there were many such “ljekarusa” who mostly grew up at the sources of national experience. In those books, the recipes are mostly based on the use of medicinal herbs. Historians of medicine believe that these medicinal books represent the cultural and historical significance of our regions.

Background: The Organized health care during Ottoman Empire was poor, and the population of Bosnia looked to the clergy of all denominations, among which the Franciscans play a significant role, for a cure for their ailments, both mental and physical. The Franciscan motto of living, not only for yourself but also for others was, also, reflected in the Bosnian Franciscans’ provision of medical services to people. Objective: The aim of this article was to show, based on the available literature, the development of medicine and pharmacy in Bosnia and Herzegovina from the medieval period until the Second World War with description methods of treatment, medicinal forms and preparations that were used in the mentioned period. Methods: The subject of this study was the development of medicine and pharmacy in the areas of Bosnia and Herzegovina from the 14th century until the Second World War. In order to achieve the set goals, a) Retreival of professional and scientific literature and b) Search of scientific databases and web pages on the Internet that offer adequate and relevant data and historical facts related to the subject of studies were carried out. Most of the facts are covered in previously published articles by the author and deposited in the PubMed and PubMed Central databases, as well as in books and monographs by the author of this text. Results and Discussion: In the Middle Ages, folk medicine was present, in which herbalists looked for medicines in certain plant and animal species. In the 13th century, Bosnia was settled by the Franciscans, who permanently marked the development of medicine and pharmacy. They are educated at prestigious universities abroad, from where they bring their knowledge, skills and recipes and write them in books, which are called ljekaruse (medicine books). Every historical period brought some changes for medicine and pharmacy, so the Ottoman Empire brought customs of frequent cleaning, public fountains and hammams were built. During the reign of the Austro-Hungarian Monarchy, the first hospitals and pharmacies were established, and laws on pharmacy activity were introduced. Written documents on the history of the medicine and pharmacy development in Bosnia and Herzegovina are mostly found in the libraries of monasteries, and a significant number of them are also in the libraries of madrasas, and the National and University Librarie in Sarajevo and the former Institute of Hygiene in Sarajevo. Conclusion: In connection with the medical and pharmacy practice of the Bosnian Franciscans, the question of the various medical records that they created, which helped them in their health efforts, stands out. First of all, we are talking about numerous medicinal books, so called ”ljekaruse”. On the soil of Bosnia and Herzegovina, there were many such “ljekarusa” who mostly grew up at the sources of national experience. In those books, the recipes are mostly based on the use of medicinal herbs. Historians of medicine believe that these medicinal books represent the cultural and historical significance of our regions

Background: Pulmonary Embolism (PE) represents a life-threatening medical emergency that, given the serious complications, requires urgent application of anticoagulant therapy. In addition to other factors that are taken into account when choosing a therapy for treatment of PE, the anatomical distribution of thrombi is also considered–whether it is a central, lobar, segmental or subsegmental PE. D-dimer is an intermediate product of degradation of fibrin molecules and its values in the plasma are increased in the case of PE, but also in other diseases. Objective: To determine whether there is a difference in D-dimer values in subjects with different anatomical distribution of PE. Methods: The study included 100 subjects with diagnosed PE by using MSCT and/or V/P SPECT and with measured values of D-dimer. Results: Out of 100 subjects, PE was not diagnosed in 37 subjects, while 63 subjects PE was diagnosed. All subjects with diagnosed PE were divided into 3 groups regarding the anatomical localization of thrombus: lobar, segmental or subsegmental. Average D-dimer values were calculated for all 3 groups. Statistical analysis showed that there was no significant difference in D-dimer values between subjects with different anatomical distribution of PE. Conclusion: There is no significant difference in D-dimer values between subjects with different anatomical distribution od PE–lobar, segmental and subsegmental PE.

Background: The association between diabetes mellitus type 2 (T2DM) and pulmonary embolism (PE) is still unclear. Objective: The aim of this study was to determine the prognostic value of prothrombotic, proinflammatory markers, and troponin for pulmonary embolism and its complications in patients with type 2 diabetes mellitus. Methods: The retrospective cohort study included 294 patients with type 2 diabetes mellitus divided into two groups: (a) the first group with pulmonary embolism (n=165); (b) the control group without pulmonary embolism (n=129). The data were collected from May 2018 to May 2023. In all patients we analyzed: anthropometric parameters, laboratory parameters (troponin, D-dimer, CRP, fibrinogen, uric acid, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), arterial blood pressure, antiphospholipid antibodies, HOMA-IR index, CT angiography of the pulmonary artery, rate of adverse clinical events in pulmonary embolism (need for inotropic catecholamine support, fibrinolysis, cardiopulmonary resuscitation) and rate of intrahospital mortality from pulmonary embolism. Results: Troponin levels were significantly higher in the PE group compared to the non-PE group (p = 0.002). D-dimer, CRP, uric acid, fibrinogen and HOMA- IR were significantly elevated in the PE group compared to the non-PE group (p < 0.001). Patients with pulmonary embolism in T2DM proved to have significantly more in-hospital death within 10 days of hospital admission (p<0.001), compared to patients with T2DM, without pulmonary embolism. Conclusion : Prothrombotic, proinflammatory markers, and troponin have good prognostic value for short-term outcomes in PE among patients with T2DM.

Background: Lyme disease (Lyme disease-LD) is a disease of humans and animals that is transmitted by hematophagous insects, especially ticks. The causative agent is the spirochete Borrelia burgdorferi, a bacterium with a complex structure and a slow biorhythm, which has the ability to coat the host's organism with mucus - create a biofilm - or turn into a cyst, and the host does not recognize it and does not create antibodies. This is the reason why, in 10-60% of cases, Borrelia tests are negative, even though it is present. The diagnosis of LD is made clinically, and it is confirmed serologically and microbiologically by isolation and/or detection of the causative agent by the PCR method from tissue samples and body fluids. Lyme disease stage II and III is called „the great imitator“ because its symptoms resemble those of other diseases, so diagnostic errors are often made. Objective: In this article we presented a case of stubborn urticaria in a 28-year-old saleswoman. Case presentation: Mother of two children, who was ruled out by clinical examination for autoimmune diseases and allergies to available allergens. We subsequently confirmed the diagnosis of chronic borreliosis, caused by five types of borrelia, serologically, after advanced intermittent antibiotic therapy, and after acquired food intolerance was discovered. In the available literature, we did not find information that chronic generalized urticaria was caused by Borrelia in combination with food intolerance. Conclusion: The presented case of a patient with chronic urticaria indicates that similar cases with urticaria, as well as all skin changes with intermittent walking symptomatology, should: Undergo clinical treatment, rule out immunological diseases and drug allergies, then test for Borrelia (ELISA+ immunoblot with Borrelia protein sequences!). Take into account the duration of the disease, the possibility of the disappearance of antibodies created in early childhood or a false-negative finding of antibodies, and in case of a negative finding, do not give up ex-yuvantibus therapy.

Rheumatic heart disease (RHD) is the leading cause of valvular heart disease in underdeveloped nations. It remains a significant public health issue in Sub-Saharan African countries. This study aimed to determine the pattern, severity, and complications of RHD in Somalia. This was a retrospective cross-sectional study of all patients diagnosed with rheumatic heart disease. A total of 8526 echocardiographic examinations were done in our center over a two-year study period from January 2020 to December 2021. Patients with congenital cardiac disease, post-operative cases, myxomatous and old age degenerative disease were all excluded. Of 433 patients, 286 (66.1%) were female, and the mean age was 46.5 ± 20.3. The isolated mitral valve (MV) affected 222 (51.3%). Dual involvement of mitral and aortic valve (AV) was present in 190 (44%). Overall isolated or combined valve involvement, mitral regurgitation (MR) was the most common valve lesion 345 (79.7%), followed by mitral stenosis (MS) 160 (37%). According to the severity of lesions, severe MR was 230 (53.1%) patients, followed by severe MS (n=129, 29.8%). The most common complication of RHD depicted in our study were secondary pulmonary hypertension and enlarged left atrium, 23.8% (n=103) and 19.6% (n=85), respectively. In conclusion, in our study majority of RHD patients were females. Both isolated and in combination, MV was the most commonly affected, and mitral regurgitation was the most common valvular lesion. In our study high percentage of patients already had complications at the time of diagnosis.

Objective. Long-term care represents a series of health and social care services that are provided at home or in an institutional environment to people with reduced functional capacity (reduced physical and/or cognitive abilities) who need support in performing daily activities, and who depend on the help of others for a long time period. The goal of the research was to examine the quality of life of users with long-term health care, with a special focus on comparing the quality of life between people placed institutionally and outside of the institution. Methods. The research was designed according to the principle of a cross-sectional study. In the research, a general questionnaire and a scale for assessing the quality of life Short Form 36 Health Survey (SF-36) were used. Among the statistical tests, the ch2 square test was used. The usual value of p<0.05 was taken as the level of statistical significance. Results. Subjects who were institutionalized had statistically significantly lower values of domains and summary scores of quality of life compared to subjects whose health care took place outside of institutions, whereby the difference was observed in physical functioning (p<0.001), social functioning (p=0.003) and mental health summary score (p=0.015). Conclusion. Users of long-term health care placed in an institution had significantly worse physical functioning, a higher level of limitations due to physical problems, worse general health, a lower level of social functioning, as well as mental health.

Objective. Aging is characterized by the loss of abilities in the psychological and physical sense. Detailed assessment of cognitive status may enable early identification of high-risk patients who are candidates for dementia. The aim of this research was to examine the cognitive status of elderly people over 65 years of age living in the community and potential risk factors that contribute to the onset of dementia. Methods. The research was designed according to the principle of a cross-sectional study. The research used a general questionnaire, subjective and objective assessment of respondents, Mini Kog assessment. The ch2 square test was used for statistical tests. The usual value of p<0.05 was taken as the level of statistical significance. Results. Females (80.2%) had better cognitive status than males (84.6%) (ch2 =0.189; p=0.664). Respondents with the lowest level of education (primary school) had a worse cognitive status (23.5%) compared to 13.3% of respondents with an intermediate level of education (ch2 =9.139; p=0.010). 8.8% of respondents who socialize with friends had a good cognitive score compared to 0% of respondents with a good cognitive score who do not socialize with friends (ch2 =18.243; p=0.000), also, the cognitive status was worse in those respondents who used different aids (75%) versus 17% of those who do not use different aids for their functional mobility (ch2 =8.832; p=0.003). Conclusion. Dementia is present in a high percentage among elderly people. The level of education and the use of aids are potential risk factors for the onset of dementia.

Aging implies a process during which changes occur in the function of all organic systems in the human body. For a detailed assessment of the health status of an elderly person, a comprehensive geriatric assessment (CGA) is recommended. CGA is defined as a multidisciplinary diagnostic and therapeutic approach that enables the identification of medical, psychosocial and functional limitations of an elderly person, all with the aim of developing a coordinated plan to improve the health of the elderly person. The aim of this review was to point out the significance, comprehensiveness, applicability and prognostic significance of geriatric assessment based on data from recent literature and by searching available electronic databases. Studies were collected from the electronic databases MEDLINE (via Ovid), Pubmed, COBSON database and Google Scholar database, as well as by manual search of relevant studies cited in the references of key articles. The search for papers as a whole is limited to the English language. All studies that used a comprehensive geriatric assessment in their methodology, in elderly people over 65 years of age, were included. CGA is very important for the elderly, for their families, health systems of countries, health professionals as well as the social community. Interventions resulting from a CGA are one way to improve the performance of activities of daily living in elderly patients. CGA has numerous advantages in practice, it is comprehensive, applicable, economically relatively acceptable and as such can be routinely implemented at different levels of health care. CGA has a high prognostic significance for the early detection of multimodal problems in the geriatric population.

Background: A laboratory professional concerned with the quality of work in medical-biochemical laboratories ensures the accuracy and precision of laboratory analyses through the implementation of international and European guidelines for working with hazardous substances, through the availability and implementation of Standard Operating Procedures (SOPs). Laboratory hazards that affect the concentration and safety of workers arise from laboratory deficiencies such as: lack of preventive measures, knowledge and skills implemented through SOPs and good laboratory practice. Biophysical hazards in medical laboratories are manifested by needles and sharp objects, infectious materials, noise, vibration, radiation, poor air quality, temperature inversions. Objective: The aim of the research was to raise awareness of the quality of work in medical-biochemical laboratories in order to ensure the safety of workers. Methods: A cross-sectional questionnaire-based study was conducted among 100 laboratory professionals from Bosnia and Herzegovina (BiH) and Croatia. The research was conducted over a period of three months. Results: A higher percentage of exposure to infectious agents and needles and sharp objects was found among respondents from BiH compared to CRO (p=0.018 and p=0.001, respectively). We found that respondents employed in accredited laboratories are aware of exposure to hazards in a high percentage related to infectious agents, toxins (p=0.0012 and p=0.0046, respectively). A significant statistical difference was found between respondents with BiH and respondents with CRO in terms of knowledge of accreditation standards of medical-biochemical laboratories (p=0.0155). Respondents who have standard operating procedures available are aware of the hazards of infectious agents (p=0.0001), toxins (p=0.0466), needles and sharp objects (p=0.0052), noise (p=0.0030), vibration (p=0.0007) and extreme temperatures (p=0.0014). Conclusion: Efficient implementation and continuous compliance with the ISO 15189: 2018 standard requires constant commitment and active participation of laboratory staff. Laboratories must have standard operating procedures in place and actively monitor their use.

Introduction: COVID-19 is an infectious disease caused by the severe acute respiratory syndrom coronavirus 2 and causes a series of respiratory symptoms. Considering the appearance and development of symptoms, the course of COVID-19 can go from mild to severe. Depending on the course of COVID-19, the laboratory parameters change a lot, trying to defend the organism against the foreign pathogen and all the changes it causes. Therefore, the aim of this study is to observe the differences between biochemical, hematological and coagulation parameters depending on the disease stage of COVID-19 patients. Material and methods: We conducted cross-sectional study which included 160 COVID-19 patients from Sarajevo, Bosnia and Herzegovina. Biochemical, hematological and coagulation analyzes were performed. Results: COVID-19 patients with a severe clinical course have higher average values of fibrinogen (6.53±4.47,p<0.001), D-dimer (6.89±7.81, p<0.001), APTT (32.05±5.96, p=0.002), eosinophil (0.66±0.09, p=0.002) and CRP (93.42±75.86, p= 0.023), and lower values of lymphocytes (1.04±0.98, p<0.001), monocytes (0.45±0.3, p<0.001), compared to COVID-19 patients with a mild clinical course. COVID-19 patients with a severe clinical course had higher average values of neutrophils (10.12±5.80, p=0.002) and lower values of reactive lymphocytes (0.02±0.03, p<0.001) compared to COVID-19 patients with a mild clinical course. Conclusion: Biochemical, hematological and coagulation parameters can be a sensitive and specific biomarker for distinction of mild and severe COVID-19.