INTRODUCTION Association of Helicobacter pylori (HP) infection with the length of dialysis in dialysis patients is contradictory. This study was conducted in order to determine the association between the duration of dialysis and the HP infection status in the dialysis patients. Furthemore, biochemical parameters were monitored in two subject groups that were included in this study. SUBJECTS AND METHODS The study included 51 patients on chronic hemodialysis program who had gastrointestinal symptoms. The subjects were divided in two groups per the length of dialysis treatment. In this study we analyzed age, gender, the time period since the onset of the chronic hemodialysis program, body mass index, biochemical parameters, and whether the patients have arterial hypertension and/or diabetes. The presence of HP antigen was determined in the stool samples with use of he UlcoGnost AG test plate. RESULTS The incidence of HP infection in hemodialysis patients, with some of the gastrointestinal symptoms, was 25.5%. Patients on hemodialysis for less than 24 months had lower incidence of HP infection than those on hemodialysis program for more than 24 months. HP positive and HP negative subjects were also compared by gender, age, biochemical parameters and body mass index. There was no statistical significant difference between the groups in any of those characteristics. When comparing the HP status of the subjects with the presence of arterial hypertension and diabetes, no statistically significant difference was found between the groups. CONCLUSION This study showed negative correlation between HP infection and the length of hemodialysis program. Analysis of age, gender, body mass index, biochemical parameters, presence of arterial hypertension and/or diabetes showed no statistically significant difference was found between the hemodialysis patients who were HP positive and those who were HP negative. Additional studies are needed to elucidate the correlation mechanism between the HP infection and the duration of dialysis, in order to examine how long the dialysis time period is the most susceptible to HP infection, and then to improve the prognosis of patients with renal disease.

Background: Sleep is a complex process involving the interactions of several brain regions, which play a key role in regulating the sleep process, particularly the brainstem, thalamus, and anterior basal brain regions. The process of sleep is accompanied by a change in body functions, as well as a change in cerebral electrical activity, which is under the control of the autonomic nervous system. Objective: The aim of the study was to analyze the frequency of stroke recurrence and disability of patients with stroke and apnea. Methods: It was analyzed 110 acute stroke patients with sleep apnea. All patients were evaluated with: Glasgow scale, The American National Institutes of Health Scale Assessment, Mini Mental Test, The Sleep and snoring Questionnaire Test, The Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale, and The general sleep questionnaire. Results: The largest number of patients with apnea on admission had a degree of disability of 4, and on discharge of 1. There was a statistically significant difference between the mean values of incapacity for admission and discharge. The student’s t - test did not determine a statistically significant difference in disability according to the Rankin scale between patients with and without apnea at admission (t = 0.059, p = 0.95) and discharge (t = 0.71, p = 0.48). According to the NIHS scale, patients of both sexes with apnea had a neurological deficit of 7.55 ± 5.22 on admission and 7.1 ± 4.3 without apnea. Statistically significant difference was not found on the neurological deficit of both sexes, with and without apnea, at admission and discharge. With apnea, there were 13 relapses of stroke during one year, and without apnea in only 3 patients. Conclusion: Patients with acute stroke have a significantly higher correlation rate according to sleep apnea. There is no significant correlation in the degree of disability between patients with and without apnea.

BACKGROUND To determine the effect of lockdown measures on lung transplant patients during the COVID-19 pandemic. SUBJECTS AND METHODS We collected data from Croatian lung transplant patients before and after the lockdown and analyzed changes in weight, BMI, lung function and blood lipid status. RESULTS An average increase of 3.74 kg (+4.92%) body weight during the 4 month lockdown period was observed. Lung function values and blood lipid status remained stable. CONCLUSION Such weight gain could have detrimental effects on the morbidity and mortality of lung transplant patients. Further follow up is needed to determine the long term impacts of this observation.

Fiscal sustainability should be defined in the relation between public finances and sustainable economy. It requires a fiscal policy aimed not only at a fiscal balance, but also at the well-being of future generations, while taking the economic, social, environmental and institutional dimensions into account. The objective of this paper is to examine the relationship between fiscal sustainability and efficiency on the example of large cities in Poland in the period from 2008 to 2019. In order to obtain empirical results, a data envelopment analysis and panel data analysis were applied, and a fiscal sustainability index was constructed by means of a multidimensional approach. Based on a sample of 66 large cities in Poland, the results showed that there is a negative relationship between fiscal sustainability and efficiency. These results, however, relate to a specific period in the history of Polish cities when the local debt limits were tightened. The improvement in efficiency allowed local government units to allocate saved local expenditures to the partial repayment of previously incurred local debts. By doing so, Polish cities fulfilled tightened fiscal rules, but their service-level solvency decreased.

OBJECTIVES In this international, multicenter study, using third-generation dual-source computed tomography (CT), we investigated the diagnostic performance of dynamic stress CT myocardial perfusion imaging (CT-MPI) in addition to coronary CT angiography (CTA) compared to invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). BACKGROUND CT-MPI combined with coronary CTA integrates coronary artery anatomy with inducible myocardial ischemia, showing promising results for the diagnosis of hemodynamically significant coronary artery disease in single-center studies. METHODS At 9 centers in Europe, Japan, and the United States, 132 patients scheduled for ICA were enrolled; 114 patients successfully completed coronary CTA, adenosine-stress dynamic CT-MPI, and ICA. Invasive FFR was performed in vessels with 25% to 90% stenosis. Data were analyzed by independent core laboratories. For the primary analysis, for each coronary artery the presence of hemodynamically significant obstruction was interpreted by coronary CTA with CT-MPI compared to coronary CTA alone, using an FFR of ≤0.80 and angiographic severity as reference. Territorial absolute myocardial blood flow (MBF) and relative MBF were compared using C-statistics. RESULTS ICA and FFR identified hemodynamically significant stenoses in 74 of 289 coronary vessels (26%). Coronary CTA with ≥50% stenosis demonstrated a per-vessel sensitivity, specificity, and accuracy for the detection of hemodynamically significant stenosis of 96% (95% CI: 91–100), 72% (95% CI: 66–78), and 78% (95% CI: 73–83), respectively. Coronary CTA with CT-MPI showed a lower sensitivity (84%; 95% CI: 75–92) but higher specificity (89%; 95% CI: 85–93) and accuracy (88%; 95% CI: 84–92). The areas under the receiver-operating characteristic curve of absolute MBF and relative MBF were 0.79 (95% CI: 0.71–0.86) and 0.82 (95% CI: 0.74–0.88), respectively. The median dose-length product of CT-MPI and coronary CTA were 313 mGy·cm and 138 mGy·cm, respectively. CONCLUSIONS Dynamic CT-MPI offers incremental diagnostic value over coronary CTA alone for the identification of hemodynamically significant coronary artery disease. Generalized results from this multicenter study encourage broader consideration of dynamic CT-MPI in clinical practice. (Dynamic Stress Perfusion CT for Detection of Inducible Myocardial Ischemia [SPECIFIC]; NCT02810795)

Aim: Orthodontic brackets during their wear cause demineralization of enamel, which is the initial step in caries development. The prevention of such spots is crucial to ensure healthy teeth, but patients’ compliance is not the most optimal way. The aim of this study was to compare the antimicrobial properties of fluoride-containing orthodontic materials to the materials without additional fluoride. Materials and Methods: Antibacterial effectiveness of orthodontic materials with fluoride – Transbond Plus SEP Bonding agent, Transpond Plus Adhesive agent, Fuji I Band cement, Fuji Ortho LC Adhesive agent, Ortho Solo Bonding agent, and without antimicrobial substances – Transpond XT Bonding agent, Transbond XT Primer were tested with the inhibition on most common causes L. achidophilus (ATCC 4356) and S. mutans (ATCC 10449) and compared to negative control. Antimicrobial effectiveness of each material was measured with the agar diffusion method and expressed with the diameters of inhibition zones around the disk. Results: Materials containing fluoride showed more antimicrobial effectiveness compared to materials without fluoride or negative control (p<0.001), respectively. Materials from the group with no antibacterial substances were not statistically different compared to the negative control (P>0.05). Conclusion: Materials containing fluoride showed more significant antimicrobial effectiveness when compared to the materials without antimicrobial substance and thus might have the potential of antimicrobial properties in vivo.

Background: The accessory deep peroneal nerve (ADPN) is as an anomalous nerve derived from the superficial peroneal nerve or its branch and supplies motor innervations for extensor digitorum brevis (EDB) and sensory innervations for the lateral part of the ankle and foot regions. It is the most common anomalous innervation present in the lower limb. Objective: The aim of this study was to determine the prevalence of ADPN electrophysiologically in a sample of Bosnia and Herzegovina subjects who referred to an electromyography lab. Methods: This cross-sectional descriptive study included 316 lower limbs from 171 subjects referred for electrodiagnostic studies to Electromyography Lab, Department of Neurology, University Clinical Center Tuzla (Bosnia and Herzegovina) (102 females/60% and 69/40%) males). Motor nerve conduction studies for the peroneal nerve and ADPN were done. Compound muscle action potential (CMAP) and nerve conduction velocity (NCV) of deep peroneal nerve (DPN) were measured by using EMG machine by stimulating DPN at knee, ankle and lateral malleolus areas accordingly, with recording from extensor digitorum brevis (EDB) muscle. Results: ADPN was found in 46 (14.5%) of 316 legs. ADPN was found in 18 (39.1%) right lower limbs and 28 (60.9%) left lower limbs. Ten subjects (5.8%) had bilateral ADPN. There was no statistically significant difference between the occurrence of ADPN in women versus men (p=0.757), as well as in right versus left legs (p=0.237). Conclusion: This study demonstrated that ADPN prevalence, in a sample of Bosnia and Herzegovina subjects who referred to an electromyography lab is 14.5%. Recognition of ADPN is very important for proper interpretation of lower limbs electrophysiological data.

Abstract Worldwide, cities are implementing circular economy (CE) strategies to reduce the resources they consume and their environmental impact. However, the evidence of the intended and unintended social consequences of the transition to “circular cities” is scattered. The lack of a coherent overview of the evidence on the subject can hinder effective decision-making in policy and practice. This study examines the extent to which the current literature addresses the social impacts that a transition to a CE produces in cities. We used a methodological approach related to systematic mapping to collate the evidence published over the past decade globally. The study finds that social impacts have rarely been considered in studies of circular cities, and where they have been discussed, the scope has been quite limited, only covering employment (mostly of informal sector workers) and governance practices. This scoping review highlights the need to further analyse and integrate social impact considerations into decision-making connected to transitions towards circular cities.

SUMMARY Providing in-patient nursing care inevitably involves shift work and shift patterns have been identified as an important factor in determining well-being and satisfaction among nurses. Shifts of 12 h or longer have become increasingly common for nurses in hospitals in some European countries. Longer shifts offer a potential to benefit from a compressed working week, with fewer work days and more days off-work, lower commuting costs, and increased flexibility. Most people find shift work less desirable compared to standard working hours. A cross-sectional cohort study was conducted at the Mostar University Hospital in 2019. A total of 157 subjects participated in the study, 22 (14%) of which were male (medical technicians) and 135 (86%) female (nurses). The mean age of study subjects was 33.3 years (min=20, max=54, SD=8.033). Results of this study suggested that nurses working irregular rotating shifts, with more family members to look after and more than 18 years of professional experience were affected by sleep disturbances between shifts. The study showed that shift work nurses had significantly higher levels of cortisol and prolactin compared with first-shift nurses/medical technicians. The results of this study are expected to stimulate further studies of sleep disturbances among shift nurses.

Abstract Infections with various bacteria, especially gram-negative aerobes, are a well-recognized problem in captive cold-blooded animals with immunocompromised health status, or in those kept under poor conditions. Pseudomonas is one of the most represented genera. Here, we present a case of fatal disseminated infection caused by Pseudomonas aeruginosa in a captive green iguana kept at the “Pionirska dolina” Zoo in Sarajevo, Bosnia and Herzegovina. At necropsy, severe stomatitis, pneumonia, hepatitis and nephritis, accompanied with focally extensive dermatitis were observed. Histopathology revealed multifocal necrosis in various visceral organs. Culture and subsequent MALDI-TOF MS analysis were conducted to identify the isolate as P. aeruginosa. Antimicrobial susceptibility testing revealed a wide susceptibility of the isolate, however applied therapy was instilled too late in the presented case. This case demonstrates the significance of timely and accurate identification, and antimicrobial susceptibility testing of bacterial isolates implicated in the pathology of captive reptiles. The importance of monitoring the adequate environmental conditions (enclosure temperature, humidity and conformation), health status and possible clinical signs of illness are highlighted.

Introduction and Objectives: There have been concerns with the level of misinformation regarding coronavirus disease 2019 (COVID-19) and its treatment, drug shortages, as well as increased use and prices of anti-malarials, antibiotics and hygiene products during the recent pandemic. Community pharmacists can play a significant role in disease prevention and treatment in the fight against COVID-19 including providing hygiene information and medicine availability across Africa and generally. Consequently, there is a need to review the role of community pharmacists in preventing unintended consequences during any pandemic as well as the impact of COVID-19 on the demand, availability and prices of suggested medicines for its management. Materials and Methods: Multiple approaches involving a qualitative review of the management of COVID-19 across countries coupled with a pilot study in Ghana among six purposely selected community pharmacists during the early stages of the pandemic assessing patterns of demand, availability and prices of medicines suggested for the management of COVID-19. Alongside this, pharmacists' future role enhancing appropriate medicine use in Ghana and wider combined with the help of senior level co-authors. Results: The majority (five out of six) of pharmacists in Ghana reported increased demand for hydroxychloroquine, antibiotics and vitamins as immune boosters resulting in shortages with price increases particularly for anti-malarials. Conclusion: The global lockdown had impacted on the supply and prices of medicines in Ghana similar to other countries. Community pharmacists can play a key role with encouraging safe medicine use, reducing self-purchasing of medicines and planning workflows during future pandemics including vaccinations. They can also help address potential misinformation and its consequences as well as the unintended consequences of pandemics including better management of non-communicable diseases.