Abstract Background: Limited data exist on training of European paediatric and adult congenital cardiologists. Methods: A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries. Results: Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87–9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63–10.72 million), and one training centre per 4.29 million population (range 1.63–10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1–17), and duration of training was 3 years (range 2–5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R2 = 0.41). Conclusion: Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists.

Background: Mental health, substance abuse and suicidal ideation present an emerging healthcare problem during COVID-19 pandemic as a result of socio-epidemiological measures, isolations, work modifications, constant media overload with COVID-19 related news and no effective cure for the disease. Objective: The aim of this study was to analyse substance abuse, suicidal ideation and mental health status among university students during the COVID-19 outbreak in Bosnia and Herzegovina. Methods: This cross-sectional study, was conducted via an online anonymous questionnaire based on a Patient Health Questionnaire-4 and Impact of Event Scale-6 which was distributed to the student population of Bosnia and Herzegovina. Results: In total 827 subjects, the majority of whom were female (636), had a high school degree (431), were unemployed (587), lived in an urban environment (747) and had a median age of 23.0 (21.0,32.0), completed the questionnaire. Being female [(OR=1.643, p=0.040); (OR=1.643, p=0.032)], taking sedatives [(OR=1.519, p<0.001); (OR=1.250, p=0.029)] and having high IES-6 score [(OR=2.190, p<0.001); (OR=2.013, p<0.001)] were independent predictors of developing depressive and anxiety symptoms during the COVID-19 outbreak, respectively. Suicidal ideation was present in 71 subjects, with 11 attempting to commit suicide. Sedative (OR=1.381, p=0.005) or alcohol (OR=1.493, p=0.002) use, unemployment (OR=4.551, p<0.001) and depressive symptoms (OR=7.261, p<0.001) were independent predictor of developing suicidal ideation. Conclusion: Bosnia and Herzegovina students show a significant prevalence of anxiety and depressive symptoms, trauma- and stressor-related disorder related to the pandemic, suicidal ideation and substance abuse during the COVID-19 outbreak, especially in association with gender, occupation and abuse of a specific substance.

This study aimed to analyze treatment guidelines of 12 SEE countries to identify non-pharmacological interventions recommended for schizophrenia, explore the evidence base supporting recommendations, and assess the implementation of recommended interventions. Desk and content analysis were employed to analyze the guidelines. Experts were surveyed across the 12 countries to assess availability of non-pharmacological treatments in leading mental health institutions, staff training, and inclusion in the official service price list. Most SEE countries have published treatment guidelines for schizophrenia focused on pharmacotherapy. Nine countries—Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Moldova, Montenegro, North Macedonia, and Serbia—included non-pharmacological interventions. The remaining three countries—Kosovo (UN Resolution), Romania, and Slovenia—have not published such treatment guidelines, however they are on offer in leading institutions. The median number of recommended interventions was seven (range 5–11). Family therapy and psychoeducation were recommended in most treatment guidelines. The majority of recommended interventions have a negative or mixed randomized controlled trial evidence base. A small proportion of leading mental health institutions includes these interventions in their official service price list. The interventions recommended in the treatment guidelines seem to be rarely implemented within mental health services in the SEE countries.

Coronavirus disease 2019 (COVID-19) is primarily a disease of the respiratory system but severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause several immune-related complications including different neurological disorders, such as myelopathy with paraparesis.In this atypical case a female patient with progressive spastic paraparesis after COVID-19 infection, brisk reflexes and positive Babinski sign, reduced vibratory sensation to the thoracic level, elevated immunoglobulin levels (IgG) in cerebrospinal fluid, but negative magnetic resonance imaging (MRI) of the brain and spine, is presented. A 57-year-old woman with spastic paraparesis and inability to walk was admitted to our neurological department. About four months before hospitalization, she started feeling numbness and tingling in the feet and lumbar spine area. Gradually, numbness and tingling ascended to the thoracic spine level Th7/8, and she developed weakness mostly in her legs. In the neurological exam she had spastic paraparesis. MRI of the brain, cervical and thoracic spine did not reveal any signal abnormality. Serological testing for SARS-CoV-2 was performed and results were highly positive IgG and IgM+IgA levels. The lumbar puncture finding confirmed the suspicion of immune-related complications after SARS-CoV-2 infection (intrathecal IgG synthesis). This case draws attention to spastic paraparesis or progressive MRI-negative myelitis after SARS-CoV-2 infection, which obviously has immune-mediated pathogenesis that happen in response to the virus or its antibodies. Similarities in spastic paraparesis after human T-lymphotropic virus (HTLV-1) or human immunodeficiency virus (HIV-1) and SARS-CoV-2 infections were observed. The patient had a good response to corticosteroid therapy and had good recovery.

Architectural patterns are solutions to common problems in software design. These usually tackle one or more customer requirements (business, functional, or quality requirements). As continuous deployment becomes more important for satisfying customer’s experience in software projects, there is a greater need in supporting continuous integration as its prerequisite. The nature of architectural design patterns is that some are more suitable for continuous integration then others. However, the existing approaches do not prescribe how to tailor architectural design considering integration challenges.To identify patterns suitable for continuous integration, we present a methodology for identification of architectural design patterns that support continuous integration based on continuous assessment. Our methodology, based on Aglie, enables DevOps engineers to assess their integration experience considering design changes, implementation changes, and creation of new version deliverables. The methodology complements common DevOps activities and introduces templates for communicating feedback from DevOps engineers to architects. Architects handle the communicated feedback as requirements and optimise their design accordingly. In this way, the design decisions take shape of solution patterns that, besides other existing requirements, satisfy requirements necessary to facilitate continuous integration.

Background Most trials comparing endovascular treatment (EVT) alone versus intravenous thrombolysis with alteplase (IVT) + EVT in directly admitted patients with a stroke are non-inferiority trials. However, the margin based on the level of uncertainty regarding non-inferiority of the experimental treatment that clinicians are willing to accept to incorporate EVT alone into clinical practice remains unknown. Objective To characterize what experienced stroke clinicians would consider an acceptable level of uncertainty for hypothetical decisions on whether to administer IVT or not before EVT in patients admitted directly to EVT-capable centers. Methods A web-based, structured survey was distributed to a cross-section of 600 academic neurologists/neurointerventionalists. For this purpose, a response framework for a hypothetical trial comparing IVT+EVT (standard of care) with EVT alone (experimental arm) was designed. In this trial, a similar proportion of patients in each arm achieved functional independence at 90 days. Invited physicians were asked at what level of certainty they would feel comfortable skipping IVT in clinical practice, considering these hypothetical trial results. Results There were 180 respondents (response rate: 30%) and 165 with complete answers. The median chosen acceptable uncertainty suggesting reasonable comparability between both treatments was an absolute difference in the rate of day 90 functional independence of 3% (mode 5%, IQR 1–5%), with higher chosen margins observed in interventionalists (aOR 2.20, 95% CI 1.06 to 4.67). Conclusion Physicians would generally feel comfortable skipping IVT before EVT at different certainty thresholds. Most physicians would treat with EVT alone if randomized trial data suggested that the number of patients achieving functional independence at 90 days was similar between the two groups, and one could be sufficiently sure that no more than 3 out of 100 patients would not achieve functional independence at 90 days due to skipping IVT.

The COVID-19 pandemic has caused a major disruption of the everyday lives of children and adolescents around the world. Although adolescents are generally not at risk of developing severe COVID-19, 1 they were heavily impacted by changes in their daily lives, including social isolation due to school closures and physical distancing, decreased peer interactions, restrictions on physical activity, and increased family stress. 2,3 While social distancing measures helped contain the virus, they also caused notable adverse effects on adolescents ’ mental and physical health. Several cross-sectional 4,5 and longitudinal studies 6 based on the general adolescent population reported increased prevalence of mental illnesses during the COVID-19 pandemic, and meta-analysis of pooled data including 80.879 children and adolescents revealed that the prevalence of depression and anxiety, the two most common mental health concerns in youth, have doubled compared with pre-pandemic estimates and remained high also later in the pandemic. 7 Adolescents with preexisting chronic medical conditions were exposed to additional precipitants of psychological stress during the pandemic such as missed or delayed healthcare appointments, uncertainty about the advancement of the disease, protective behaviors with quarantining, feeling of helpless-ness, and possible shortage of supplies of medicines. 8 Therefore, from a mental health perspective, it appears that they may be affected differently with the potential for a widening of existing disparities in health and developmental outcomes.

Abstract Objective: The present study aimed to: i) determine the contractile properties of the major lower limb muscles in female soccer players using tensiomyography; ii) investigate inter-limb differences; and iii) compare inter-limb differences between different selections and playing positions. Methods: A total of 52 female soccer players (A team; U19 and U17) were recruited. The vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), biceps femoris (BF), gastrocnemius medialis (GM), lateralis (GL) and tibialis anterior (TA) of both lower limbs were evaluated. Results: When the entire sample was assessed regardless of selection or playing position, there were significant inter-limb differences in all measured muscles except BF. Compared to the non-dominant limb, the dominant limb had higher delay time in VL (p=0.008), while showing lower values in VM (p=0.023), GL (p=0.043) and GM (p=0.006). Contraction time was lower in the RF of the dominant limb (p=0.005) and VM (p=0.047), while showing higher values in VL (p=0.036) and TA (p<0.001) as compared to the non-dominant limb. Conclusion: Given the differences found between the limbs in the whole sample studied, it is necessary to examine both limbs to gather a more in-depth understanding of underlying mechanisms related to neuromuscular functions in female soccer players. Level of evidence: Prognostic study, Level II.

The aim of the present study was to investigate whether the physiological parameters indicative of cardiorespiratory fitness obtained during the 30-15 intermittent fitness (30-15IFT) test and the multistage laboratory treadmill endurance (TR) test differ. Nineteen elite handball players were recruited for the current study and assigned in a cross-over manner to one of two tests to be performed 48 h apart at each visit to the testing facility. The results showed that VO2max (percentage difference [PC] = 6.1%; p = 0.004) and maximal running velocity (V) (PC = 19.4%; p < 0.001) were significantly higher for the 30-15IFT test than that obtained during the TR test. Furthermore, the onset of blood lactate accumulation was shown to be significantly higher for all measures considered to predict it during 30-15IFT compared to TR as follows: VO2max (PC = 12.6%; p = 0.001), running speed (PC = 33.9%; p < 0.001), and maximal heart rate (PC = 7.5%; p < 0.001). The current study highlights the importance of sport-specific testing, particularly for measuring individual cardiorespiratory fitness in elite handball players, as TR may underestimate crucial variables used for both diagnostics and training prescription.

Background: Stroke patients have sleep-wake disorders, mostly in form of insomnia, excessive daytime sleepiness/fatigue, or hypersomnia (increased sleep needs). Objective: The aim of this study was to analyze types of sleep disorder (SD) and their frequency in patients with sleep apnea and acute stroke in relation to the type of stroke and side of lesion. Methods: The study analyzed 110 patients with sleep apnea and acute stroke hospitalized in the Clinic of Neurology, University Clinical Centre Tuzla. Acute stroke has been verified either by computerized tomography or magnetic resonance imaging of the brain. SD was verified according to the Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale and the General sleep questionnaire. Strokes were divided by: a) type, into hemorrhagic and ischemic, and b) the localization of the stroke, to right and left cerebral hemispheres. Results: Of the total number of respondents, all had some sleep disorder. 20% of respondents had severe level of SD, 35.4% moderate, 37.3% moderate- severe and 7.3% mild problems. There were no statistically significant differences in the frequency of SD among patients with ischemic and hemorrhagic stroke (p = 0.58). In relation to the side of lesion, there was more patient with SD and stroke in the both sides, but there were no statistically significant differences (X2=1.98, p=0.161). According Epworth Sleepiness Scale, Stanford Sleepiness Scale and Berlin Questionnaire test snoring was present in 81% and daytime sleepiness in all patients. Conclusion: SD as a neuropsychological disorder has a significant incidence in the acute phase of stroke in patients with sleep apnea. Sleep disorder is more common in ischemic stroke and stroke in the both hemisphere, but it is not statistically significant difference. Daytime sleepiness, fatigue and snoring are the most common sleep problems in patients with acute stroke and apnea, but it is not statistically significant.

Aim of the study Most of the malignancies leading to obstructive jaundice are diagnosed too late when they are already advanced and inoperable, with palliation being the only treatment option left. Due to progressing hyperbilirubinaemia with its consequent adverse effects, biliary drainage must be established even in advanced malignancies. This study aims to investigate and analyse factors that affect clinical outcomes of percutaneous trans-hepatic biliary drainage (PTBD) in patients with obstructive jaundice due to advanced inoperable malignancy, and identify potential predictors of patient survival. Study design: Observational retrospective cohort study. Material and methods Baseline variables and clinical outcomes were evaluated in 108 consecutive patients treated with PTBD. The study’s primary endpoints were significant bilirubin level decrease and survival rates. Secondary endpoints included periprocedural major and minor complication rates and catheter primary and secondary patency rates. Results PTBD was technically successful and bile ducts were successfully drained in all 108 patients. Median serum bilirubin level, which was 282 (171-376) µmol/l before drainage, decreased significantly, to 80 (56-144) µmol/l, 15 days after stent placement (p < 0.001). Patient survival ranged from 3 to 597 days and the overall (median) survival time following PTBD was 168 days (90-302). The 1, 3, 6, 12 and 18-month survival rates were 96.3%, 75.9%, 48.1%, 8.3% and 1.9%, respectively. Multivariate analysis revealed that liver metastases and alkaline phosphatase were significantly associated with mortality. The overall complication rate was 9.3%. Conclusions PTBD is a safe and effective method to relieve jaundice caused by advanced inoperable malignant disease. Careful patient selection is necessary when introducing PTBD in order to avoid invasive procedures in patients with a poor prognosis.

Background: Multiple sclerosis (MS) is a chronic disease characterised by a wide range of symptoms and a highly unpredictable prognosis, which can severely affect patient quality of life. Objective: The aim of the study was to evaluate the influence of gender, age and marital status on health-related quality of life (HRQoL) in MS patients. Methods: This study included 100 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were an Expanded Disability Status Scale score between 1.0 and 6.5, age between 18 and 65 years, stable disease on enrollment. HRQOL was evaluated by the Multiple Sclerosis Quality of Life-54 questionnaire (MSQoL-54). Mann-Whitney and Kruskal-Wallis test were used for comparisons. Linear regression analyses were performed to evaluate prediction value of gender, age and marital status on both physical and mental HRQOL Results: Women had significantly lower QOL scores then men in pain scale (55.00 vs. 76.67; p<0, 05). Younger patients had better physical (54.58 vs. 37.90; p<0.05) and mental health (59.55 vs. 45.90; p<0.05) composite scores. Patients with earlier age of onset scored significantly higher in health perception domain scale (45.00 vs. 32.50, p<0.05). Married patinets scored higher in physical and mental composite scores but with no significant difference except in sexual function (87,51 vs 70, 86, p<0,05) and emotional well being (66,67 vs 33,33; p<0,05) scales. Patient age retined its independent predictivity of physical health composite score (r2=0.063). Conclusion: Aging in MS proved to be important negative factor in predicting physical domains of QOL. Interventions for reducing difficulties caused by physical limitations in older patients, higher level of psychological support for patients with late onset disease and social support for those living alone are important factors in improving HRQOL in MS patients.

During 2019, 28 grave constructions were excavated at cemetery Metaljica (Hadzici municipality, Bosnia and Herzegovina). Archaeological excavation have revealed 17 well preserved skeletons that were subjected to anthropological, odontological and genetic analyses. To determine sex by genetic analysis, amelogenin and DYS391 loci were taken into consideration. Concordance between results of anthropological, odontological and genetic analyses applied in this research occurred in one sample out of 17. In four samples, sex was determined only by genetic analysis, since sexual dimorphism indicators were not preserved. Concordance between odontological and genetic determinations was observed in two samples, while affirmative results of anthropological and genetic analysis were obtained in only one sample. Discrepancy in the majority of samples can be atributted to the state of preservation of skeletal remains, interpopulation differences and allele drop-out. Moreover, anthropological and odontological analyses were not applicable to juvenile/subadult skeletons, since sexually dimorphic characteristics relevant for metric and morphological analysis are not developed well at that developmental period. This study emphasizes the importance of combining anthropological, odontological and genetic methods in order to determine sex of archaeological skeletal remains accurately.

This issue, 75/1 is mostly dedicated to the environmental impact of landslides, which, due to current climate change, are becoming more and more pronounced around the world and in the Republic of Croatia. The six papers (BOSTJANČIĆ et al., 2022, Fig. 1 poly­ gon 1; FILIPOVIĆ et al., 2022, Fig. 1 polygon 2; FRANGEN et al., 2022, Fig. 1 polygon 3; GULAM et al., 2022, Fig. 1 polygon 4; PODOLSZKI et al., 2022, Fig. 1 polygon 5; POLLAK et al., 2022, Fig. 1 polygon 6) focusing on landslides are the result of the work of a large team of people from the Croatian Geological Sur­ vey, carried out within the framework of the safEarth project, cofinanced by the ERDF and IPA II funds of the European Union. As a part of the Interreg IPA – Cross-border Cooperation Programme Croatia – Bosnia and Herzegovina – Montenegro 2014-2020, the safEarth project was based on cross-border coop­ eration of four partner institutions, namely the Croatian Geological Survey (lead partner), Geological Survey of Montenegro, Faculty of Mining, Geology and Civil Engineering of the Univer­ sity of Tuzla and the Development Agency Žepče d.o.o. The main project activities were focused on landslide susceptibility maps (LSM) as one of the most important data sets in spatial planning The use of high-resolution LiDAR scanning in the research of small landslides based on Croatian examples