OBJECTIVE To present a rare disease, and to point out that clinical manifestations treated for a long period of time without an adequate response to therapy may be a manifestation of a rare disease. CASE REPORT We present the case of a 3-year-old girl who had been drinking a large amount of water for the previous ten days with frequent urination, and who experienced the worsening of symptoms of scalp dermatitis that had been treated for a year without success. Physical examination revealed a maculopapular rash on the scalp, neck and both ear shells, and exophthalmos of the right eye with periorbital edema. Magnetic resonance imaging of the orbits showed extensive lesions of the skull bones. Further diagnostic evaluation revealed similar lesions in other bone structures. Biopsy of the affected region, microscopic and immunohistochemical analysis led to diagnosis of Langerhans cell histiocytosis. CONCLUSION Langerhans cell histiocytosis mostly occurs in the first three years of life. The incidence is 4-5 patients per million children under 15 years of life. The clinical presentation is highly variable, and can range from isolated, self-healing skin and bone lesions to life-threatening multisystem diseases. Due to the diverse clinical picture, that is often unrecognized, these patients are often referred to other specialists, resulting in the treatment of individual symptoms rather than the underlying disease.

Aim To explore patient's awareness and appliance of the fasting state requirements for blood sampling. Methods This observational survey was performed at the Department of Medical Biochemistry and Immunology Diagnostics, Cantonal Hospital Zenica, from June to July 2019. An anonymous questionnaire was conducted on 200 consecutive outpatients older than 18, who were admitted to the laboratory for routine blood testing. Results A total of 134 (67%) patients were informed that they needed to be at fasting to perform laboratory tests. Patients were mostly informed by a requesting physician or a nurse, 68 (50.8%), and by other patients, members of the family and friends, 58 (43.3%); only seven (5.2%) patients were informed in the laboratory. A total of 75 (37.5%) patients arrived to the laboratory properly prepared. Conclusion Most patients were not well informed about fasting state requirements for blood sampling and consequently they were not adequately prepared for laboratory tests. Laboratory should establish updated fasting recommendations available to patients and healthcare professionals, and conduct continuing education of patients and health care staff.

Aim To investigate the relationship between preoperative level of serum albumin in patients with colorectal cancer (CRC), stage of CRC and postoperative complications. Methods This cross-sectional retrospective study was conducted at the Clinic for General and Abdominal Surgery of the University Clinical Centre Sarajevo (UCCS). A total of 107 patients surgically treated for CRC in the period between 2013 and 2018 were enrolled in this study and divided into two groups: with hypoalbuminemia (group A) and without hypoalbuminemia (group B). Results The average level of albumin in group A was 29 (25-32) g/L versus 39 (37-41) g/L in group B (p<0.05). The average length of hospital stay in group A was 18 (13-25) days, and in group B 14.5 (12-21) days. Patients with hypoalbuminemia (group A) had wound dehiscence more often and more re-interventions compared to group B (p<0.05). Binary logistic regression found that serum protein, albumin and globulin levels were not statistically significant in the prediction of CRC stadium or postoperative complications (p>0.05). Conclusion Study results show that preoperatively measured levels of serum albumin are not associated with the stage of colorectal cancer and cannot serve as predictors for postoperative complications.

Aim To investigate knowledge, attitudes and practice towards COVID-19 among selected population. Methods An anonymous online questionnaire based on a Chinese study was distributed via online social media platforms among general population of Bosnia and Herzegovina, Germany, India, Kosovo and Romania. Results In total 1032 subjects, predominately females, 615 (59.6%) with a mean age of 31.23±12.94 years, single, 705 (68.3%), with high school degree or lower, 469 (45.4%), students, 528 (51.1%) and living in an urban environment, 824 (79.8%), have completed the survey. The median knowledge score was 10.0 (range 0-12). Being male (β: -0.437; p=0.003) and older (β: -0.028; p<0.001) were associated with lower knowledge scores, while being single (β: 1.026; p<0.001) and mental labour employee (β: 0.402; p=0.032) were associated with higher knowledge scores. The vast majority of subjects had not visited crowded places, 630 (61.0%) and wearing masks when they were going out, 928 (89.9%). Being female (OR=0.731; p=0.022), having higher knowledge scores (OR=0.929; p=0.017) and being a mental labour employee (OR=0.713; p=0.031) decreased the exposure to crowded places. High school or lower education level (OR=0.616; p=0.024) decreased the action of wearing a mask in public places, while higher knowledge scores (OR=1.112; p=0.013) increased it. Conclusion Our study suggests that residents of the selected regions have had good knowledge, pessimistic attitudes and relatively appropriate practices towards COVID-19 during the second wave of the outbreak.

Aim To identify laboratory tests for early detection and the development of more severe illness and death in COVID-19 hospitalized patients. Methods A prospective study was done on 66 hospitalized COVID-19 patients (males: 54.5%; mean age 70.1 ± 9.6 years) who were stratified into: moderate (n=36; 54.5%), severe (n=12; 18.2%), and critically ill (n=18; 27.3%). Besides clinical findings, a wide spectrum of laboratory parameters was monitored at admission and control during the first seven days of hospitalization and used to predict progression from non-severe to severe illness and to predict the final outcome. Results Critically ill patients showed a higher control value of white blood cell count, C-reactive protein, lactate dehydrogenase, ferritin, but lower lymphocyte count and O2 saturation. Patients with fatal outcome (23; 34.85%) showed a higher control value of neutrophil, lactate dehydrogenase, ferritin, and lower lymphocyte and O2 saturation. Progression from moderate to severe or critical illness was predicted by increasing lactate dehydrogenase (95% CI 0.5803 to 0.8397;p=0.003729), increase in ferritin (95% CI 0.5288 to 0.8221;p=0.03248), and by drop in O2 saturation (95% CI 0.5498 to 0.8179;p=0.01168). A fatal outcome was predicted by increase in ferritin (95% CI 0.5059 to 0.8195;p=0.04985), as well as by drop in O2 saturation (95% CI 0.5916 to 0.8803; p=0.001861). Conclusion Increase in ferritin, and drop in O2 saturation could be the most important prognostic parameters for the development of more severe clinical illness and death in COVID-19 hospitalized patients.

OBJECTIVE The aim of our study was to investigate the predictors of morbidity (age, gender, smoking habits, obesity and the presence of chronic diseases) and COVID-19 outcomes. SUBJECTS AND METHODS The research was an observational descriptive study, conducted at The Family Medicine Education Center, The Primary Health Care Center, Banja Luka, in the period from 26th June to 31st December 2020. During the research period, seven family medicine teams followed their patients with COVID- 19, and recorded possible predictors for morbidity and their influence on the disease outcome. RESULTS The study included 934 patients, 46.90% of whom were male. The majority of subjects were non-smokers and overweight. Diabetes was found in 5.57% patients, hypertension in 29.44%, chronic respiratory diseases in 5.25%, cancer in 4.39% patients. In the observed sample, 29.23% subjects contracted pneumonia, 18.52% were hospitalized, while 19 (2.03%) patients with severe clinical features had a fatal outcome. Multivariable regression analysis showed a high risk of pneumonia in male patients [OR=2.45, 95% CI (1.73- 3.46)], elderly [OR=1.07, 95% CI (1.06-1.09)] and obese patients with Body Mass Index ≥30.0 kg/m2 [OR=2.55, 95% CI (1.73- 3.77)]. Male gender [OR=2.19, 95% CI (1.11-4.31)], older age [OR=1.08, 95% CI (1.05-1.11)] and hypertension [OR=2.51, 95% CI (1.06-5.91)] were the most important predictors for the development of severe clinical features in COVID 19. The statistically significant predictors of mortality were male gender [OR=7.16, 95% CI (1.56-32.86)] and older age [OR=1.12, 95% CI (1.06-1.18]. CONCLUSION Being familiar with the predictors of morbidity and poor outcome in COVID-19 is helpful for carrying out preventive measures, early diagnosis and treatment of risk groups of patients.

AbstractCoanda-effect screens exclude coarse and fine debris from a variety of water intakes. Water overflows an inclined wedge-wire screen with tilted wires that shear high velocity flow from the ...

OBJECTIVE The purpose of this study was to evaluate the efficacy of daily transcutaneous tibial nerve stimulation (TTNS) versus weekly percutaneous tibial nerve stimulation (PTNS) on the quality of life of patients with idiopathic overactive bladder (OAB). PATIENTS AND METHODS The study was designed as a randomized controlled trial. The diagnosis of OAB was made on the basis of clinical symptoms, and urodynamic tests were performed to check whether uncontrolled contractions of the derusor during bladder filling were responsible for the OAB symptoms. The tests used to assess symptoms and quality of life were Overactive Bladder Questionnaires (OAB-q) SF. The patients were divided into 2 groups of 30 patients each. The first group was treated with TTNS every day for 3 months and the second group with PTNS once a week, also for 3 months. RESULTS Stimulation with both TTNS and PTNS led to the reduction of all clinical symptoms of OAB and improved quality of life, with statistical significance (P<0.05) and with no side effects. When comparing these two groups, the improvement was statistically more significant in the group treated with PTNS. When the quality of life scores and symptoms were compared to the type of treatment, it was found that the improved quality of life parameters and the reduced OAB symptoms were more statistically significant in the treatment with PTNS than TTNS therapy (P<0.001). CONCLUSION The results of the study suggest good efficacy of both TTNS and PTNS in the treatment of OAB. Better effects are achieved with weekly PTNS, as it leads to a statistically significant reduction in symptoms as well as an improvement in quality of life, without side effects.

Aim To determine the relationship between seasonal changes in ambient temperature, humidity and general and specific mortality rates in the area of Zenica-Doboj Canton. Methods Changes in the average monthly mortality in the period from 2008 to 2019 were analysed (linear regression) in relation to the average temperatures and humidity in those months in the same time period in Zenica-Doboj Canton. Results Overall mortality increased from 7.9 ‰ in 2008 to 10.2 ‰ in 2019. Overall and specific mortality rates for cardiovascular, malignant, respiratory and metabolic diseases followed seasonal change of ambient temperature and humidity. The monitoring trend showed strong determination degree for overall mortality and mortality for cardiovascular, malignant and respiratory diseases, while for metabolic diseases it was somewhat lower. The highest mortality rates were found in January (cold month), and in August (warm month); the lowest one was in May, September and October. There was a strong significant negative correlation between temperature and mortality rates, while the correlation between humidity and mortality rates was not significant. Conclusion As we have proven that mortality rates followed seasonal changes in ambient temperature and determined months with the least mortality rate, the community must take measures to ensure microclimatic conditions for the survival of patients with cardiovascular, malignant, respiratory and metabolic diseases.

Abstract Introduction: Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD). The aim of this study was to analyze the presence of frailty phenotype among HD patients and to evaluate their interrelationship with different biochemical markers. Methods: For the frailty assessment the Frailty Phenotype by Fried et al. was used, where frailty was reported if three of the following criteria were met: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. From 281 HD patients, 126 patients were frail, 58 were pre-frail (two criteria were met) and the rest of the study population were robust (97 patients). BMI was calculated for all patients and venous blood samples were taken to determine laboratory parameters for bone alkaline phosphatase (BAP), phosphate (P), potassium (K), C-reactive protein (CRP) and albumin. Results: Patients who were on HD longer than 60 months have more characters of frailty. (p=0.019). A statistically significant positive correlations between frailty score and BAP (rho = 0.189; p = 0.001), and CRP (rho = 0.233; p < 0.001) were observed, and significant negative correlations between frailty score and albumin (rho = - 0.218; p < 0.001) and K (rho = - 0.198; p = 0.001). Conclusions: The associations of frailty with markers of mineral bone disorder, inflammation and nutrition indicate the importance of these parameters in the indirect assessment of the frailty phenotype in HD patients.