Background/Aim: Antibiotic use and resistance represent a growing public health issue, with a specific risk of uncontrolled use of antibiotics in children. The aim of the study was to examine differences in parental knowledge, attitudes and practices about antibiotic use in children between urban and rural areas of the Republic of Srpska. Methods: A cross-sectional study was conducted among 1459 parents of children under 6 years of age, out of which 1201 (82.3 %) lived in urban areas while 258 (17.7 %) lived in rural areas. The research is conducted among parents who brought their children to the selected primary healthcare centres and among parents of children in preschool institutions. Results: The majority of respondents (98.4 %) state that doctors are their main source of information. Only 61.2 % of respondents precisely know which drug is an antibiotic when offered different drugs and respondents from rural areas (54.3 %) more often (p = 0.012) gave more accurate answers when compared to respondents from urban areas (37.3 %). Among parents, 86 % agree with the statement that improper use of antibiotics reduces their effectiveness and leads to bacterial resistance, regardless of groups. More than a half of respondents (52.4 %) do not think that children with flu or common cold symptoms recover faster when they receive antibiotics, significantly more respondents from urban areas (p = 0.001). Respondents from rural areas significantly more often believe that antibiotics can produce harmful effects compared to respondents from urban areas (p = 0.049). Respondents from rural areas significantly more often think that antibiotic use can prevent complications caused by inflammation of the upper respiratory tract (p = 0.006). Parents from rural areas give their children antibiotics without a paediatrician's recommendation significantly more often (4.3 %) compared to respondents from urban areas (0.6 %) (p < 0.001). Conclusion: There are differences in parental knowledge, attitudes and practices regarding antibiotic use and antimicrobial resistance among parents in rural and urban areas. There is need for additional education of parents and for greater engagement of paediatricians in providing guidance and explanations regarding the use of antibiotics.

According to the World Health Organization (WHO) and the International Society for Hypertension, elevated blood pressure is defined as the blood pressure the readings of which consistently range ≥140 mmHg systolic and/or 90 mmHg diastolic. Having in mind the fact that hypertension is one of the leading risk factors for cardiovasluar disease, kidney failure and premature mortality, it is clear that preventive measures should be imposed before the diagnosis is established. The main nutritional measures used in preventing hypertension are: weight loss, Dietary Approaches to Stop Hypertension (DASH diet), reducing salt and alcohol intake and increasing potassium intake. The aim of this paper was to show the preventive effect of the DASH diet on hypertension onset in normotensive patients as well as to highlight that the diet is an integral part of hypertension treatment, in addition to the use of drug therapy for hypertensive patients.

Background: A significant number of patients who underwent surgical myocardial revascularization (CABG) have various comorbidities, including left ventricular diastolic dysfunction (LVDD). Objective: The aim of this paper is to show that patients with preoperative LVDD are at an increased risk of postoperative adverse events and have a worse prognosis compared to patients without LVDD. Methods: The study included 116 patients who underwent myocardial revascularization (CABG) performed at Medical Institute Bayer in Tuzla over a period of 1 year. None of the patients had previously undergone CABG or valvular surgery, or undergone stent implantation (PCI). The presence of LV diastolic dysfunction was detected by echocardiography, and the patients were divided into two groups: with and without LVDD, and further classified into three degrees of LVDD. Results: Of the total number of subjects who underwent surgical revascularization of the myocardium without echocardiographically detected LVDD, 24.1% were patients, and 75.9% were patients with LVDD. In the group with LVDD, the range of days spent in the intensive care unit (ICU) is significantly higher compared to patients without LVDD. Also, patients with LVDD had a significantly higher number of hours of inotropic support, a significantly higher number of cases of tachycardia, predominantly atrial fibrillation (POAF). In this group of patients, a greater number of other adverse events were observed, such as myocardial infarction, cardiac or renal failure, TIA or CVI. Of the total number of patients in the study, 107 patients survived surgical myocardial revascularization and had a satisfactory recovery while 9 (7.8%) survived, all from the group with LVDD. Conclusion: Patients with preoperative diastolic dysfunction of the left ventricle, especially with III degree of dysfunction, are exposed to a higher postoperative risk of adverse events such as: atrial fibrillation, prolonged stay in the intensive care unit, the need for longer-term support with inotropes, and the fatal outcome was recorded exclusively in patients with LV diastolic dysfunction.

Introduction. The human voice is an important characteristic that enables the distinction of human from other living beings. Otherwise, it represents a picture of a person΄s personality, his health, mental and emotional state. The research aims are to determine the voice characteristics of vocal professionals with diagnosed vocal cord nodules by subjective voice assessment and objective voice measurement before and after vocal rehabilitation. Methods. This study has involved 25 examinees, aged 23 to 56. The subjective voice assessment was conducted with the Voice Handicap Index - VHI questionnaire and the objective voice measurement by a computerized laboratory for voice analysis ''Kay Elemetrics''. The obtained data were processed using descriptive and analytical statistics. Results. Before the vocal rehabilitation and the subjective and objective voice measurements, the examinees had greater psychosocial difficulties associated with their voice quality. After two months of vocal rehabilitation, there has been a significant improvement in the voice of all subjects on the VHI scale. A statistically significant and highly statistically significant improvement have been noticed in six out of seven analyzed parameters of vocal A, by the objective measurement of voice. Namely, the obtained values - the percentage of jitter Jitt (%), the percentage of shimmer Shim (%), the relative average perturbation value RAP (%) and the coefficient of fundamental frequency variation - vFo were highly statistically significant (p < 0.01). The VTI - voice turbulence index and the SPI - soft phonation index also improved, the observed difference was statistically significant (p < 0.05), while the observed difference in the FTRI parameter was not statistically significant (p > 0.05). Conclusion. Vocal rehabilitation has influenced the improvement of the voice quality, which means that the results obtained by objective voice measurements were more in accordance with the results of the subjective voice assessment.

Introduction Infective endocarditis is relatively rare in pediatric population, but can result in significant morbidity and mortality. Children with bicuspid aortic valve are at higher risk of developing infective endocarditis as compared to general population. Our objective is to emphasize the importance of rapid diagnosis and proper treatment of infective endocarditis in patients with bicuspid aortic valve with aim to prevent serious adverse events. Case outline We report a case of a 13-year-old girl with newly diagnosed bicuspid aortic valve who developed infective endocarditis with severe complications and underwent cardiac surgery. Recurrent fever and anemia, as well as cardiac murmur were present for six months prior to diagnosing infective endocarditis. During the course of illness, only one of many blood cultures taken was positive for Streptococcus sanguinis. Conclusion Patients with bicuspid aortic valve require careful evaluation for infective endocarditis, especially if recurrent fever associated with anemia is present. Delayed diagnosis of infective endocarditis is associated with serious complications.

Our aim was to determine the prevalence of potential drug-drug interactions (pDDIs) and to identify relevant factors associated with the occurrence of the most dangerous or contraindicated pDDIs (pCDDIs) in hospitalized patients with spontaneous intracerebral hemorrhage (sICH). A retrospective cross-sectional study was performed enrolling all consecutive patients with sICH treated at the Neurological Intensive Care Unit, Clinical Center in Kragujevac, Serbia, during the three-year period (2012-2014). The inclusion criteria encompassed patients aged 18 years and over, those diagnosed with ICH, and those prescribed at least two drugs during hospitalization, while we did not include patients whose hospitalization lasted less than 7 days, those who were diagnosed with other neurological diseases and patients with incomplete medical files. For each day of hospitalization, the online checker Micromedex® software was used to identify pDDIs and classify them according to severity. A total of 110 participants were analysed. A high prevalence of pDDIs (98.2%) was observed. The median number of pDDIs regardless of severity, was 8.00 (IQR 4.75-13.00;1-30). The pairs of drugs involving cardiovascular medicines were the most commonly identified pDDIs. Twenty percent of the total number of participants was exposed to pCDDIs. The use of multiple drugs from different pharmacological-chemical subgroups and the prescribing of anticoagulant therapy significantly increase the chance of pCDDI (aOR with 95% CI 1.19 (1.05-1.35) and 7.40 (1.13-48.96), respectively). This study indicates a high prevalence of pDDIs and pCDDIs in patients with sICH. The use of anticoagulant therapy appears to be the only modifiable clinically relevant predictor of pCDDIs.

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Introduction: Laboratory and anthropometric parameters for assessing lipid metabolism disorders are important for atherogenesis and the occurrence of cardiovascular disease. Material and Methods: The study was designed as a prospective longitudinal study, meant to assess the risk of cardiovascular disease, which included initial measurement of lipid status, CRP, and BMI, and repeated measurement after DASH diet and exercise. It was conducted on a sample of 60 female respondents. Results: Following the WHO categorization of BMI, the study found that 62% of respondents were overweight, 26% were obese, and only 12% of respondents were at ideal body weight. After the DASH diet and exercise program, the average value of BMI M = 27.02 was established. Analyzing the values of the CASTELLI 1 index in 95.9% of respondents, high values of M = 5.3 were observed, which indicates a high risk of CVD. The study results indicate that the average value of cholesterol, triglycerides, LDL-C significantly reduced after two months of adherence to the DASH diet and exercise. With the help of Spearman’s rank, the correlation coefficient indicated the existence of a positive relationship between the CASTELLI 1 index and total cholesterol, triglycerides and HDL-C. In the initial analysis, CRP had a high value (M = 10 mg/L). In contrast, after the program, the CRP value decreased to (M = 4 mg/L), and a significant negative correlation (p <0.01) was observed between CRP and HDL-C, indicating that HDL-C value as a protective lipoprotein for blood vessels increased. CRP decreased after two months of DASH diet and exercise. Conclusion: With this research, we aim to draw attention to the importance of promoting healthy lifestyles and creating adequate risk assessment models with a well-developed strategy that will include anthropometric, laboratory and other multidisciplinary aspects to combat cardiovascular

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People consumed salt exclusively through food millions of years ago, which amounted to less than 0.5 g/day. Recent researches indicate that the average daily consumption of salt is more than 10 g/day. The general conclusion of studies investigating the relationship between dietary salt intake and blood pressure led to recommendations on reducing salt intake and limiting total intake to 5 g of salt per day by the World Health Organization and the European Safety Agency of Food. Increased salt intake causes suppression of the Renin-Angiotensin-Aldosterone system by reducing sodium renal excretion. Also, an increase in salt intake leads to an increase in the concentration of sodium in the blood, which causes high secretion of vasopressin and causes high blood pressure. Namely, bread is a basic food and is high in salt, but the salt parameter is not mandatory in accordance with the regulations. Today, almost every EU country has different strategies that include recommending salt reduction through food reformulation to reduce the salt content of food, including bread and bakery products. Achieving and maintaining the reduction of the population's salt intake will soon give a great benefit in terms of the prevention of cardiovascular events as the first cause of death globally, then great savings for the health system and an individual.