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H. Tahirovič, Brigitte Fuchs

This article describes the life and medical activities of Jadwiga Olszewska (1855-1932) in Serbia from 1895-1899, AustroHungarian (AH)-occupied and annexed Bosnia and Herzegovina (BH) from 1899-1918, and the newly founded Kingdom of Yugoslavia, from 1919-1932. In summer 1899, Olszewska replaced Teodora Krajewska as an AH official female physician in Tuzla. Born in Congress Poland, Olszewska had enrolled in 1873 in the medical courses for women in St. Petersburg but had left Russia in 1880 to study medicine in France. She had lived as a student and single parent in Paris since 1883, and she was awarded her Doctorate in Medicine from the University of Paris in 1894. She could not practice medicine in Russian-occupied Poland because of her French diploma, and she could not practice in most Western countries due to her gender. Therefore, she decided to move to Serbia, where she worked as an assistant physician in the district hospitals of Loznica (1895-1897?) and Požarevac (1897-1899). Driven by the need for a higher income to fund her son's education, she engaged her network of Polish compatriots and procured the position of an AH official female physician of Tuzla in 1899, where she performed her duties in an exemplary manner. After the breakdown of the Austro-Hungarian Empire (AHE) in 1918, Olszewska remained in Tuzla and retired as a Yugoslav official physician in 1923. When she died in Tuzla in 1932, local colleagues had to arrange for a proper funeral because Olszewska did not leave any savings due to her insufficient pension. Olszewska's grave never received a tombstone, and it is untraceable today. CONCLUSION: Jadwiga Olszewska (1855-1932) was a woman pioneer of medicine from Poland, who practiced her profession first as an assistant physician in Serbia (1895-1899) and then as an AH and Yugoslavian official female doctor in Tuzla, BH (1899-1923).

N. Mlačo, Armin Šljivo, Ahmed Mulać, A. Kurtovic-Kozaric, A. Pašić, S. Bešlija, Šejla Cerić, Timur Cerić

Aim To investigate quality of life and exposure to lifestyle risk factors of cancer patients in Bosnia and Herzegovina and a correlation of cancer type with lifestyle risk factors. Methods This was a cross-sectional study conducted on 200 cancer patients from the Clinical Centre of the University of Sarajevo. The respondents completed an anonymous questionnaire consisting of seven sections: basic patient information, physical activity, dietary habits including alternative medicine, tobacco use, alcohol consumption, anxiety, and comorbidities. Results A total of 150 (75%) patients were overweight with 113 (56%) of them being less physically active after the confirmed diagnosis. After the diagnosis, 79 (40%) patients ate less food, and 154 (77%) healthier; 130 (65%) reported consumption of alternative medicine and food supplements, 39 (30%) spent >1/4 of average monthly salary on these products. Majority never consumed alcohol, 135 (68%) and 101 (51%) patients reported history of tobacco use. Being obese was an independent predictor for colorectal carcinoma; being less obese was linked to a decreased risk of breast cancer diagnosis. Physical activity was linked to a decreased risk of lung cancer diagnosis. Many patients (122; 61%) reported having chronic comorbidities, mostly hypertension, while 44 (22%) patients were proven to be clinically anxious. Conclusion Our data suggest lack of public awareness of the consequences of unhealthy lifestyles. Risk factors such as alcohol consumption and tobacco use differed from other European countries. Significance of lifestyle changes after the diagnosis for reducing mortality and cancer recurrence requires further research. Prevention programs and more data are needed.

Aim To examine whether preoperative tumour size may serve as a biomarker for the occurrence of lymphovascular invasion (LVI) in centrally and peripherally located lung adenocarcinoma. Method The study included 261 patients surgically treated for diagnosed lung adenocarcinoma. A ROC curve was used to determine the biomarker potential of tumour size relative to the occurrence of LVI. Binary logistic regression was used to show changes of tumour size impact on the status of LVI. Result Tumour prevalence according to localization had no statistical significance (p=0.464), while the presence of LVI in central, as well as peripheral positions, was statistically significantly different (p<0.001). The area under the curve of 0.978 highlights the fact that tumour size is an excellent marker of the presence of LVI in centrally located adenocarcinomas of the lung. A similar finding was confirmed in peripherally located lung adenocarcinomas with an area below the curve of 0.943. Binary logistical regression showed that in centrally localized adenocarcinomas of the lung, each additional centimetre of tumour growth represents an increase in the likelihood of LVI+ by 17.14 times. In peripherally located adenocarcinomas of the lung, this increase in likelihood of LVI for each centimetre of growth was 5.46 times. Conclusion With a high degree of sensitivity and specificity, preoperative tumour size may serve as an important biomarker and positive predictor of the presence of LVI in lung adenocarcinoma of any location.

Aim To determine a status of systolic function in patients with diabetes mellitus (DM) type 2 with ST-segment elevation acute myocardial infarction (STEMI), to determine values of cardiac biomarkers in patients with DM type 2 with STEMI and correlate the parameters with ejection fraction of left ventricle (EFLV). Methods A total of 80 patients were divided into two groups, the study group (group I) consisting of 40 patients admitted with the diagnosis of DM type 2 and STEMI, and a control group (group II) with 40 patients with STEMI without diagnosed DM type 2. Cardiac biomarkers - creatine kinase MB fraction (CKMB), and troponin I were monitored. The EFLV was evaluated echocardiographically (using Simpson method) five days after primary percutaneous coronary intervention (pPCI). Results In the group I the EFLV five days after pPCI was significantly correlated with troponin values (with a minimum r = -0.47; p=0.002, a maximum r = -0.339; p = 0.032, as well as with an average value of r = -0.389; p=0.013), and with an average CK value (r = -0.319; p=0.045). In the group II there was a significant negative correlation of EFLV with the maximum value of troponin (r = -0.309; p=0.05). Conclusion Troponin values have an effect on the EFLV after STEMI, and thus on the left ventricular status, as well as on the pharmacological modality itself.

Introduction: Upper gastrointestinal bleeding can be a life-threatening condition and requires careful evaluation from the very first episode in order to reduce the risk of rebleeding, hemorrhagic shock and death. The outcome of a patient with upper gastrointestinal bleeding depends on resuscitation measures taken during admission to the hospital and an adequate assessment of the patient’s risk level. Aim: The aim of the study is to compare Glasgow Blatchford score and Rockall score and to identify the most accurate score used in predicting unfavorable outcomes and the need for intervention. Methods: This study involves 237 patients with upper gastrointestinal bleeding. The accuracy of the scoring systems was assessed by plotting receiver-operating characteristic curves (ROC curves) and was calculated for GBS and RS with 95% confidence interval (CI). Results: As for mortality prediction, RS was superior to GBS (AUC 0.806 vs. 0.750). The GBS had a higher accuracy in detecting patients who needed transfusion units and was superior to the RS (AUC 0.810 vs.0.675). In predicting the need for intervention, RS was superior to GBS (AUC 0.707 vs. 0.636. Conclusion: GBS and RS are developed to help clinicians to triage patients appropriately in order to assess endoscopic therapy within a suitable time frame, as well as identify low risk patients for possible outpatient management. High accuracy of the GBS in predicting a need for transfusion represents an important endpoint to assess. RS was superior to GBS in predicting a need for intervention as well as mortality. Currently, a combination of these scoring systems is the best way for proper assessment.

Introduction: Microdissection testicular sperm extraction (microTESE) is considered the gold standard method for surgical sperm retrieval among patients with non-obstructive azoospermia (NOA). Aim: This study aimed to evaluate the correlation between histopathological findings after failed microTESE procedure and outcomes of the „second-look“ procedure and to provide insight into the most common histopathological patterns after testicular biopsy within our population. Methods: The retrospective study included 33 selected patients with NOA, who had undergone unsuccessful sperm retrieval. The diagnosis of NOA was made after the assessment of the patient’s history data, a physical examination, semen analysis, the hormonal profile, and genetic studies. After negative sperm retrieval, histopathological report has been analyzed for „second-look“ microTESE attempt. Results: Five testicular histopathological patterns were found: hypospermatogenesis (9,1%), Sertoli cell-only syndrome (43%), germ cell maturation arrest (15%), seminiferous tubule hyalinization (15%), mixed pattern (21%). Y-microdeletions were detected in 5 patients, of which 3 patients showed AZFc region deletions. Only 3 patients (9,1%) underwent a „second-look“ procedure after the evaluation of histopathological reports. After the stimulation therapy and „second-look“ procedure, we had a positive outcome in a single patient (33,3%). Mean FSH value in patients with confirmed spermatogenesis was 17.26±3.11IU/l, while mean FSH value in patients without presence or germ cell statistically significantly exceeded and was 24.28±4.71IU/L (p=0.038). Conclusion: Histopathological reports following the microTESE procedure are obligatory for the proper selection of patients who are candidates for the „second-look“ microTESE attempt. Patients with Sertoli cell-only syndrome and hypospermatogenesis particularly can benefit from the “second-look” procedure.

Bakir Lacevic, A. Zanchettin, P. Rocco

In this paper, we approach the problem of ensuring safety requirements within human-robot collaborative scenarios. The safety requirements considered herein are consistent with the paradigm of speed and separation monitoring. In such a setup, safety guarantees for human operators usually imply limited robot velocities and/or significant distance margins, which in turn may have adverse effects regarding the productivity of the robot. In this paper, we propose a novel approach that minimally affects the productivity while being consistent with such a safety prescription. A comprehensive simulation study shows that our method outperforms the current state of the art algorithm.

N. Šabanović-Bajramović, E. Hodžić, A. Iglica, E. Begić, N. Resić, K. Aganović, M. Halilčević, S. Bajramović

Aim To evaluate a correlation of serum level of neutrophil gelatinase-associated lipocalin (NGAL) to the risk of the occurrence of complications in patients with the early phase of ST-segment elevation myocardical infarction (STEMI) treated with fibrinolytic therapy prior to percutaneous coronary intervention (PCI). Methods A total of 54 patients with the diagnosis of STEMI treated with fibrinolytic therapy (alteplase) prior to PCI were included. Patients were admitted to the Intensive Care Unit (ICU) of Clinic for Heart, Blood Vessel and Rheumatic Diseases in the period January to March 2018. All patients underwent coronary angiography and PCI within the maximum of 48 hours delay after fibrinolysis, according to the hemodynamic and electrical stability and PCI availability. Blood samples were taken immediately after admission prior to fibrinolytic administration. Patients were divided into two groups according to NGAL values (less or more than 134.05 ng/mL). Results Higher values of NGAL have effect on a higher mean systolic and diastolic pressure (p=0.001 and p=0.003, respectively). Patients with higher NGAL values also have higher values of brain natriuretic peptide (p=0.0001) and highly sensitive troponin I (p=0.002). In that group relative risk (RR) for lethal outcome was 6.4 times significantly higher (p=0.002), for the development of heart failure 2.88 times (p=0.0002), for post-myocardial infarction angina pectoris 2.24 times (p=0.0158), and for ventricular rhythm disturbances (ventricular tachycardia, ventricular fibrillation) 1.96 times higher (p=0.0108). Conclusion Increased NGAL value is related to an unfavourable outcome of patients in the early phase of STEMI treated with fibrinolytic therapy prior to PCI.

Ivan Zeljko, Barbara Gilić, D. Sekulić

The importance of agility in futsal is already recognized, but there is an evident lack of information about applicability of futsal specific tests. The aim of this study was to evaluate reliability, validity and correlates of tests evaluating the futsal specific pre-planned agility (PPA), and non-planned agility (NPA). The sample comprised 40 professional futsal players who were tested on newly developed tests of PPA and NPA, sprint over 10 meters, countermovement jump, body height and mass. The reliability analyses included calculation of intra-session Cronbach Alpha (CA) and Inter-Item-Correlation (IIR), as well as analysis (ANOVA) for repeated measurements. Differences between performance groups (starters [first team] vs. non-starters [substitutes]) were evidenced by t-test for independent samples and calculation of Effect Size differences (ES). Pearson’s product moment correlation was calculated to define associations between variables. The reliability of agility tests was appropriate, with somewhat better reliability of PPA (CA: 0.81 and 0.76, IIR: 0.79 and 0.72, for PPA and NPA, respectively). ANOVA did not reveal any significant differences among testing trials. Starters were had better PPA than non-starters (t-test: 1.98, p < 0.01, moderate ES). The PPA and NPA shared less than 40% of the common variance, which suggests that these capacities are independent. Jumping and sprinting were not significantly correlated to PPA and NPA. Study confirmed appropriate reliability of the newly developed tests, and applicability of the PPA in distinguishing performance-levels. Further studies in females and younger players are warranted.

T. Jukić, A. Ihan, V. Strojnik, D. Štubljar, Andrej Starc

Background The aim of the study was to address the working population with an occupational stress prevention program using mHealth solution and encourage them for healthy lifestyle choices. Methods Seventeen participants were randomized from the corporate setting. A 24alife app with a good compliance program was selected. Test battery has been designed to test the physical readiness, psychological evaluation and biological blood markers for stress. Participants were followed up after 30, 60 and 90 days, respectively, within the intervention period. Weight of participants was tracked three times per month. Univariate analysis compared the continuous variables by One-Way Repeated-Measures ANOVA test when the data were normally distributed, or Wilcoxon rank sum test for abnormal distribution of variables. Results Participants used the app with a compliance rate of 94.1%. The psychological evaluation revealed higher motivation for work, lower burnout scores and participants gave subjective responses of better general wellbeing. Some of the participants lost up to four kg of body mass. Physical readiness has also improved. Conclusions Results of mHealth projects on corporate could include primary health care institutions and health ministry to extend the existing system to patients’ pockets where they can monitor their disease and increase the ability of self-care.

Martina Andellini, Simone De Santis, F. Nocchi, Elena Bassanelli, L. Pecchia, M. Ritrovato

The spread of severe acute respiratory syndrome coronavirus 2, taking on pandemic proportions, is placing extraordinary and unprecedented demands on healthcare systems worldwide. The increasing number of critical patients who, experiencing respiratory failure from acute respiratory distress syndrome, need respiratory support, has been leading countries to race against time in arranging new Intensive Care Units (ICUs) and in finding affordable and practical solutions to manage patients in each stage of the disease. The simultaneous worldwide emergency caused serious problems for mechanical ventilators supply. This chaotic scenario generated, indeed, a frenetic race to buy life-saving ventilators. However, the variety of mechanical ventilators designs, together with the limitations in time and resources, make the decision-making processes on ventilators procurement crucial and not counterbalanced by the evaluation of devices quality. This paper aimed at offering an overview of how evidence-based approach for health technologies evaluation, might provide support during Corona Virus Disease 2019 (COVID-19) pandemic in ICUs management and critical equipment supply. We compared and combined all the publicly available indications on the essential requirements that ICU ventilators might meet to be considered acceptable for treating COVID-19 patients in severe to critical illnesses. We hope that the critical analysis of these data might help readers to understand how structured decision-making processes based on evidence, evaluating the safety and effectiveness of a given medical device and the effects of its introduction in a healthcare setting, are able to optimize time and resources allocation that should be considered essential, especially during pandemic period.

Radosav Djordjevic, N. Ikodinovic, N. Stojanović

The aim of this article is developing a formal system suitable for reasoning about the distance between propositional formulas. We introduce and study a formal language which is the extension of the classical propositional language obtained by adding new binary operators D≤s and D≥s, s ∈ Range, where Range is a fixed finite set. In our language it is allowed to make formulas of the form D≤s(α; β) with the intended meaning ’distance between formulas α and β is less than or equal to s’. The semantics of the proposed language consists of possible worlds with a distance function defined between sets of worlds.

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