Lung ultrasound (LUS) is a valuable, non-invasive tool for detecting pulmonary congestion in patients with acute heart failure (AHF), with a higher sensitivity relative to physical examination. However, the association between LUS-detected pulmonary congestion and cardiovascular outcomes in patients with ST-segment elevation (STEMI) is not well established. This systematic review and meta-analysis evaluated cardiovascular outcomes in patients with STEMI and congested (wet) or non-congested (dry) lungs by LUS. We searched PubMed, Embase, and Cochrane databases, and conference abstracts for clinical trials evaluating LUS-congestion (LUS+) versus non-LUS-congestion (LUS-) in patients with STEMI. Risk ratios (RRs) and hazard ratios (HR) with 95%CIs were pooled using R software under random-effects models. We also calculated LUS sensitivity, specificity, and area under the curves (AUCs) for the prediction of in-hospital mortality and cardiogenic shock. We included five studies with 1,454 patients. The mean age was 60 to 65 years; 1,066 (73.3%) were male, and 451 (31%) had congested lungs (LUS+). Patients with congestion on LUS had a significantly higher risk of the composite endpoint of death, heart failure, acute coronary syndrome, and cardiogenic shock (HR 4.00; 95%CI 2.12-7.54; p<0.01; Figure 1A). There was also a higher risk of in-hospital mortality (RR 5.09; 95%CI 2.25-11.49; p<0.001; Figure 1B) and cardiogenic shock (RR 5.01; 95%CI 2.47-10.17; p<0.001; Figure 1C) compared to patients with non-congested lungs. Reinfarction was similar between groups (p=0.08; Figure 1D). LUS had high diagnostic accuracy for in-hospital mortality (SROC-AUC: 0.82) and cardiogenic shock (SROC-AUC: 0.77); a high sensitivity (0.84; 95%CI 0.49-0.97; Figure 2A), and moderate specificity (0.78; 95%CI 0.67-0.87; Figure 2A) for in-hospital mortality; and moderate sensitivity (0.75; 95%CI 0.42-0.93; Figure 2B) and specificity (0.76; 95% CI 0.61-0.87; Figure 2B) for cardiogenic shock. Congested lungs on LUS are significantly associated with a higher risk of in-hospital mortality and cardiogenic shock in patients with STEMI. Moreover, LUS has a high AUC for identifying in-hospital mortality and cardiogenic shock in this patient population. Figure 1 Figure 2

We introduce the concept of Diophantine spherical vague set approach to multiple-attribute decision-making. The Spherical vague set is a novel expansion of the vague set and interval valued spherical fuzzy set. Three new concepts have been introduce such as Diophantine spherical vague weighted averaging operator, Diophantine spherical vague weighted geometric operator, generalized Diophantine spherical vague weighted averaging operator and generalized Diophantine spherical vague weighted geometric operator. We provide a numerical example to show how Euclidean distance and Hamming distance interact. Applications of the Diophantine spherical vague number include idempotency, boundedness, commutativity and monotonicity in algebraic operations. They can determine the optimal option and are more well-known and reasonable. Our goal was to identify the optimal choice by comparing expert opinions with the criteria. As a result, the model’s output was more accurate as well as in the range of the natural number . The weighted averaging distance and weighted geometric distance operators are distance measure that is based on aggregating model. By comparing the models under discussion with those suggested in the literature, we hoped to show their worth and reliability. It is possible to find a better solution more quickly, simply, and practically. Our objective was to compare the expert evaluations with the criteria and determine which option was the most suitable. Because they yield more precise solutions, these models are more accurate and more related to models with . To show the superiority and the validity of the proposed aggregation operations, we compared it with the existing method and concluded from the comparison and sensitivity analysis that our proposed technique is more effective and reliable. This investigation yielded some intriguing results.

Network emulators play an important role in testing network systems, applications, and protocols. Emulators bridge the gap between simulation setups that lack realism in results and real-world trials that are accurate but often expensive, non-reproducible, and uncontrollable. This article presents an extended model of the Quantum Key Distribution Network Simulation Module (QKDNetSim) with a model catalog of QKD components and functionalities. We explore emulations of point-to-point connections in QKD networks and the interaction of essential components within QKD nodes. The presented tool will undoubtedly spur future development and teaching, and it is critical for testing novel applications and protocols applied to QKD networks.

BACKGROUND Non-ST segment elevation myocardial infarction (NSTEMI) poses significant challenges in clinical management due to its diverse outcomes. Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care. AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events (MACE) in NSTEMI patients, potentially improving clinical outcomes. METHODS A prospective, observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla, Bosnia and Herzegovina. The study included 170 patients with NSTEMI, who were divided into a group with MACE and a control group without MACE. Furthermore, the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis. Alongside hematological parameters, an additional 13 hematological-derived ratios (HDRs) were monitored, and their prognostic role was investigated. RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction (NSTEMI) patients with MACE and a control group at T1 and T2. However, significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE. Notably, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were elevated in lethal outcomes. Furthermore, C-reactive protein-to-lymphocyte ratio (CRP/Ly) at T1 (> 4.737) demonstrated predictive value [odds ratio (OR): 3.690, P = 0.024]. Both NLR at T1 (> 4.076) and T2 (> 4.667) emerged as significant predictors, with NLR at T2 exhibiting the highest diagnostic performance, as indicated by an area under the curve of 0.811 (95%CI: 0.727-0.859) and OR of 4.915 (95%CI: 1.917-12.602, P = 0.001), emphasizing its important role as a prognostic marker. CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients. During follow-up, NLR, PLR, and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.

Introduction/Objective. Introduction/Objective Following the failure of the single-wire technique in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), two principal anterograde escalation strategies are commonly employed: the parallel-wire technique and antegrade wire escalation (AWE). Despite their widespread use, comparative data on the procedural characteristics and long-term clinical outcomes of these strategies remain scarce. This study aims to compare the procedural parameters and long-term outcomes of the parallel-wire and AWE techniques after single-wire failure in CTO PCI. Methods. This retrospective, single-center study included patients who underwent successful CTO PCI between January 2018 and December 2023 using either the parallel-wire or AWE technique following single-wire failure. The primary endpoint was a composite of cardiac death, myocardial infarction, stroke, or target vessel revascularization (TVR). Secondary outcomes included procedure duration, fluoroscopy time, contrast volume, and total radiation dose. Median follow-up duration was 1222 days (IQR 580-1969 days). Results. Among 270 CTO PCI procedures, 112 (41.5%) required escalation: 90with AWE and 22 with the parallel-wire technique. Baseline clinical and angiographic characteristics were comparable. The primary composite outcome occurred in 14.4% of the parallel-wire group and 9.1% of the AWE group (p = 0.73). No significant differences were observed in individual clinical events. Procedure duration was longer (95.5 ? 43.6 vs. 77.0 ? 30.7 min; p = 0.064) and contrast volume higher (336.4 ? 113.3 vs. 271.6 ? 90.6 mL; p = 0.014) in the AWE group, with similar fluoroscopy time and radiation dose. No clinically or ?ngiographically significant complications occurred during the periprocedural period. Conclusion. Both AWE and parallel-wire techniques demonstrate comparable safety and efficacy following single-wire failure in CTO PCI. While procedural efficiency slightly favored the parallel-wire strategy, overall outcomes support either approach, pending further prospective validation.

Tionite is a solid residue formed during the production of titanium dioxide through the chloride process. This material is acidic and contains a high concentration of titanium, which makes it a potential secondary resource for titanium recovery. Instead of being disposed of as hazardous waste, tionite can be processed to extract valuable metals, particularly titanium. In this study, the recovery of titanium from tionite was carried out using an autoclave leaching method under high-pressure oxygen conditions. The presence of oxygen under pressure promotes the formation of titanium oxysulfate, which enhances the dissolution of titanium into solution. This approach enables selective leaching of titanium while limiting the dissolution of other unwanted elements. The leaching experiments were designed to explore optimal conditions for efficient titanium recovery, including temperature, pressure, and leaching time. The main objective of this research is to present a viable route for the valorisation of tionite by turning a hazardous acidic waste into a valuable source of titanium. This process contributes to waste reduction in the titanium dioxide industry and supports more sustainable resource management.

According to the WHO, health is not just the absence of disease, but a state of complete physical, social and mental well-being, which is why the main goals of health are aimed at improving physical, mental and spiritual health. Health is one of the fundamental rights of every human being, a precondition for prosperity and quality of life indicator for measuring progress and the basis of steady economic growth. Today, many professions are committed to modernizing the culture of relations with the public, i.e. citizens. This is also essential in healthcare, with the aim of placing the patient’s well-being and rights at the center of attention, i.e. a culture of patient-centeredness. In order to ensure that the rights of every patient are respected, a more efficient system of protecting patients’ rights is needed at all levels, and above all in hospitals, and, patient representatives should be appointed in all hospitals. The health status of our population depends on a rapid changes, such as number of demographic, social, cultural, ethnical, and other characteristics which are for several decades in a very intensive changes, The Jakarta Declaration identified five priorities: a) Promoting social responsibility for the state of health; b) Increasing investments for development of health; c) Development of partnerships for work on health promotion; d) Increasing the capacity of society and training the individual; e) Provision of infrastructure for health promotion. Analyzes of the effectiveness of preventive activities represent a systematic assessment of the impact of public health policies, programs and practices on health outcomes. Based on them, it is possible to create basic recommendations related to public health programs, guidelines for prevention and control, and making decisions about the allocation of available funds.

Background Biological mesh derived from porcine small intestinal submucosa (SIS) has a higher porosity and is more hydrophilic than tissue derived from bovine and cow dermal tissues. Therefore, we believe SIS mesh will lead to a milder inflammatory reaction than other, polypropylene and polypropylene-polydioxanone meshes, fewer adhesions, and less mesh shrinkage. Methods Ninety rats were divided randomly into three groups: in group 1, polypropylene mesh was implanted; in group 2, polypropylene-polydioxanone; and in group 3, the SIS mesh. The meshes were fixed intra-abdominally, in the upper part of the abdomen. Ten animals from each group were sacrificed on days 7, 28, and 60 after the implantation. Relaparotomy was performed, with a left paramedial incision and the adhesions formed were assessed according to the Surgical Membrane Study Group (SMSG) score, along with the percentage of shrinkage of the mesh, and any inflammation. Results There were no differences in terms of inflammatory reaction or the formation of adhesions between the meshes tested on the 7th day after implantation. However, the shrinkage of the SIS mesh was more expressed. On days 28 and 60, the SIS mesh caused less inflammatory reaction and formation of adhesions in relation to the other meshes tested. On day 60, there was no significant difference in the size of the meshes. Conclusion This study confirmed that, despite conflicting views on biological mesh, SIS mesh results in less inflammatory reaction, less adhesion formation, and a lesser degree of shrinkage, and can take its place in hernia repair.

Venous leg ulcers (VLUs) account for most lower extremity wounds. Wound management include cleansing, debridement, infection control and applying wound dressing. There exist various types of dressings which can maintain adequate moisture, offer protection, and support the reepithelization of VLUs. The aim of this study is to evaluate the cost-effectiveness of the antimicrobial wound dressing containing ionic silver (Aquacel® Ag+Extra™) in the treatment of VLUs compared to conventional gauze dressing in Serbia. The data regarding the effectiveness and frequency of dressings for both the Aquacel® Ag+Extra™ and conventional dressing were obtained from literature sources. Only direct costs were considered, and values were taken from the published price list of health services or procurement procedures. Sensitivity analyses were performed. The total cost per patient for Aquacel® Ag+Extra™ was 34,178.76 RSD, while the total cost for gauze was 82,800.90 RSD. Besides lower costs, antimicrobial wound dressing shows higher effectiveness than the gauze, implying that Aquacel® Ag+Extra™ is the dominant strategy. The sensitivity analysis supports the robustness of the results. The use of antimicrobial wound dressing containing ionic silver is the preferred option for the treatment of VLUs due to lower costs and the higher curing rate of the wounds.

Background: Depressive disorder is characterized by a persistent low mood (sadness, irritability, or emptiness) or a loss of pleasure, accompanied by other cognitive, behavioral, or neurovegetative symptoms that significantly impair a person's ability to function. Anxiety and fear-related disorders are marked by excessive anxiety and fear, which lead to behavioral disturbances and cause significant distress or impair personal, family, social, educational, occupational, or other key areas of functioning. Objective: The aim of this study was to analyze whether there are differences in the development of depressive symptoms between COVID-19 patients and patients with symptoms of the flu or common cold. Methods: This is a prospective study that included sixty participants: thirty with COVID-19 and thirty without COVID-19. Data were collected from the ambulatory observational records of participants, documenting their symptoms. We analyzed the relationship between variables such as age, sex, education, and the level of potential depression. The participants were divided into two groups: one consisting of individuals with COVID-19 and the other of individuals without COVID-19. All participants were male and female, aged between 40 and 65 years, and had no previous history of depressive disorder. The first group consisted of patients with COVID-19 who were treated at home but were examined at our outpatient clinic and subsequently sent home. Results: Statistical data processing was performed using the Excel program and the R statistical data processing program. Percentages are calculated in relation to 30 respondents in each group.There was no statistically significant correlation between the level of education in Group 1 and the development of depression(Spearman ro=0.007, P=0.972). In Group 1 (Covid ) there is a statistically significant correlation between the age of the subjects and the development of depression (Spearman ro=0.44, P=0.015). A positive value of the Spearman correlation coefficient means that the score increases with the age of the respondent. Three questions with the highest score in group 1 were: Question 2=71, Questions 15 and 16=66, Question 14=65; three questions with the highest score in group 2 were: Question 2=74, Question 1 =50, Question 18=46. Conclusion: COVID-19 can contribute to the development of depression. In our study, 16.7% of patients with COVID-19 showed signs of depression, with 10% experiencing mild depression and 6.7% experiencing moderate depression. Patients in the first group, particularly those of older age, were more likely to develop mild or moderate depression associated with COVID-19. Additionally, no statistically significant correlation was found between the level of education in Group 1 and the development of depression.

The college years are critical to students' health as they face various challenges, including social influences and unhealthy lifestyles. Limited access to health services in residence halls increases the risk of unhealthy behaviours. The aim of this study was to investigate students' attitudes towards public health services for primary prevention in dormitories and to make suggestions for improvement. A cross-sectional study was conducted using a questionnaire among students living in halls of residence. The survey explored students' views on healthcare and the availability of preventive services for students living away from home. A total of 996 students participated (response rate 99.1%). Most were unemployed (83.9%). The most frequent preventive visits were to dentists (34.4% twice a year, 24.7% once a year), while 37.7% never visited a gynaecologist/urologist. The majority (68.6%) stated that a pharmacy was necessary in their dormitories. Basic health services include general practitioners (82.3%) and psychologists (21.4%). Attitudes towards health centres varied significantly by place of residence (p<0.001). Primary prevention should be improved by health centres with student-friendly opening hours and additional activities that promote access to healthcare and awareness of prevention.

Customer satisfaction reflects the quality of pharmaceutical services and depends on various factors, such as the quality of services, pharmacists' skills and customer' demographic characteristics. Positive experiences strengthen customer trust and loyalty. Research into user satisfaction is an important tool for improving services. The aim of the work was the analysis of user satisfaction with pharmacy services in Serbia over the last twelve years. Annual reports on user satisfaction in pharmacies from 2013 to 2024 were analyzed. Based on key indicators, a report was prepared comparing satisfaction over the years, taking into account various factors and service quality. With the exception of 2020, public, private and health center pharmacies participated every year. The highest response rate was recorded in 2015. More than 60% of users visit a pharmacy more than five times a year, usually waiting less than five minutes. The highest level of satisfaction with the availability of medicines was recorded in 2021, while overall satisfaction with services peaked in 2022. User satisfaction has remained stable, indicating good availability and quality of pharmaceutical services. The results may contribute to further improvement in practice.

From patients' perspective, the use of antibiotics to treat urinary tract infections (UTIs) in Serbia is unexplored, and therefore the aim of this study is to examine antibiotic use among these patients. An online cross-sectional study using snowball sampling was conducted during the winter of 2020/21 using a validated Google Docs questionnaire. The study included 236 female patients with a mean age of 34.9 ± 14.2 years. Most of the patients perceived UTI symptoms as severe (62.3%) and disruptive for their daily routines (51.3%). The majority of the patients (77.1%) used antibiotics by doctors' prescriptions. Other patients used antibiotics on their own and their selection. Self-treatment with antibiotics was associated with perceived symptom severity (p=0.006) and residence (p=0.017). In total, 17 different antibiotics were reported as being used for UTI treatment and the most frequent were fluoroquinolones (30.3%), cephalosporins (21.2%), and sulfonamides (15.7%). The highest consistency with national and European guidelines in doctors' decisions on antibiotic therapy was observed for treating UTIs in pregnant women (80.0%). These findings emphasize the need for education of healthcare professionals and clinical practice improvement in making rational antibiotic prescribing decisions.

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