bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of a personal Santini technique in the resolution of a complex celiac trunk aneurysm - endovascular treatment
Authors: Santini Gianpaolo , Quassone Pasquale , Tarotto Luca , Arienzo Francesco , Sarti Giuseppe
Published: April 2024

Aim
Vascular pathologies have been already explored for the most of their aspects. It is a group of pathologies with unclear ethology and with an evolution in time not easy to forecast. Treatment guidelines are conflicting. The aim of this study was to describe cases in their most practical and technical aspect, especially in complicated conditions.
Methods
This was a descriptive case report of a patient with a hepatic artery aneurysm complicated by a dissection leading up
to the splenic artery, and how the team had invented a planned treatment for the patient using a minimally invasive approach. The experience was born with the intention of showing how the endovascular approach is at least as safe as the traditional one despite the complexity of our case.
Results
The procedure was completed without any complications. After a stay in long day surgery, the patient returned home.
Conclusion
Using a minimally invasive technique allows to reduce the patient's post-operative suffering and the economic burden
on the health system.
Workload changes during the COVID-19 pandemic and effects on the flow of cancer patients in the Maxillofacial Surgery Department
Authors: Kvolik Pavić Ana , Zubčić Vedran , Kvolik Slavica
Published: April 2024

Aim
A SARS Coronavirus 2 (COVID-19) pandemic drastically changed the way the health system works. In Croatia, lockdown
measures to curb virus spread lasted from March to May 2020, and all non-essential medical procedures and patients’ visits have been cancelled. The study aimed to compare patients’ flow and interventions in the surgical department before, during and after the lockdown period.
Methods
This cross-sectional study analysed the workload at the Maxillofacial and Oral Surgery Department (Department), Osijek
University Hospital, during the COVID-19 pandemic (March-May 2020) and four subsequent months. The same period of 2019 was compared as a control. The data were subtracted from hospitals’ electronic database.
Results
During COVID-19 lockdown from March to May 2020 the number of hospitalizations (306 vs. 138), surgical procedures (306 vs. 157), and scheduled outpatient visits (2009 vs. 804), dropped significantly as compared to 2019. The number of skin tumour removals was halved (from 155 in 2019 to 58 in 2019) (p<0.001), and the number of emergency patients was unchanged in the 3-month period. A significant decrease in outpatient visits and hospital admissions continued after the lockdown (p<0.001).
Conclusion
A decrease in the number of outpatient visits, hospitalizations, and tumour removals may result in larger proportions of
patients with advanced cancers in the future. The second wave of COVID-19 pandemic is ongoing, and special effort must be paid to reduce the number of cancer patients receiving suboptimal treatment.
Comparing hand strength and quality life of locking plate versus intramedullary k wire for transverse midshaft metacarpal fractures
Authors: Pasquino Andrea , Tomarchio Alessandro , De Cruto Enio , Conteduca Jacopo , Longo Damiano , Russi Valentina , Pica Giuseppe , Meccariello Luigi , Rollo Giuseppe
Published: April 2024

Aim
In the scientific literature there are no papers that clarify which method of surgical fixation in transverse metacarpal fractures has the best functional outcomes. The aim of this study was to compare the hand strength obtained using two different methods in the treatment of these fractures.
Methods
A total of 52 patients who presented a transverse metacarpal fracture were enrolled. They were divided in two groups: 26 patients treated with K-wire (IMN) and 26 patients treated with plate and screws (PW). The evaluation criteria were: fracture healing time, performed force testing collected ultimate tensile strength and grip, the Disability Arm Shoulder and Hand (DASH) score, and the range of motion of the hand.
Results
In both groups obtained results were comparable in terms of full hand function, healing and total range of motion and DASH. Results in group K were slightly better than group PW in terms of strength and grip pain within 3 months from osteosynthesis.
Conclusion
Neither of the two techniques, either in the literature or in biomechanical studies, shows to have superior functional
outcomes for fixation of transverse metacarpal fractures. Since the K-wire is cheaper and has no intrinsic complications as compared with plating (such as scar and tendon irritation), fixation with the latter is preferable to the plate in the treatment of these fractures in non-expert hands.
The challenge of the surgical treatment of paediatric distal radius/ forearm fracture: K wire vs plate fixation - outcomes assessment
Authors: Di Giacinto Salvatore , Pica Giuseppe , Stasi Alessandro , Scialpi Lorenzo , Tomarchio Alessandro , Galeotti Alberto , Podvorica Vlora , dell’Unto Annamaria , Meccariello Luigi
Published: April 2024

Aim
Distal radius/forearm fractures in adolescent patients remain challenging injuries to treat. Distal radius/forearm bony anatomy is not completely restored with intramedullary K wire fixation. The aim of this study was to compare radiographic and functional outcomes obtained using intramedullary K wire fixation and open reduction and internal fixation in the treatment of distal radius/forearm fracture.
Methods
 A total of 43 patients who presented with distal radius/forearm fractures were enrolled and divided into two groups: 23
patients treated with K-wire (IMNK) and 20 patients treated with plate and screws (ORIF). The evaluation criteria were: fracture healing time, objective quality of life measured by the Mayo wrist score (MWS) and quick disabilities of the arm, shoulder and hand score (QuickDash), length time of surgery, complications, sport or play return, forearm visual analogic pain (FVAS), bone healing by radius union scoring system (RUSS).
Results
In both groups the results obtained were comparable in terms of functional, pain and return to play/sport after the third
month after surgery. Bone healing was faster in IMNK than ORIF but without significance (p>0.05). There was less complication in ORIF than IMNK (p<0.05).
Conclusion
The treatment of adolescent distal radius or forearm fractures remains challenging. One challenge facing the physician
is the choice of surgical technique and fixation method, which will be influenced by individual experience and preference.
The question of distal radius or forearm fractures in adolescents would be best answered with a prospective randomized study.
Radiographic evaluation of the tunnel position in single and double bundle anterior cruciate ligament reconstruction
Authors: Losco Michele , Giron Francesco , Giannini Luca , Cuomo Pierlugi , Buzzi Roberto , Giannotti Stefano , Mondanelli Nicola
Published: April 2024

Aim
To evaluate tunnel positioning on radiographs in singlebundle (SB) and double-bundle (DB) anterior cruciate ligament
(ACL) reconstruction, to evaluate if measurement is accurate and reproducible.
Methods
 Radiographs of 30 SB and 30 DB ACL reconstruction were reviewed by two examiners who measured tunnel positioning with the quadrant method on the femur (a=depth, b=height) and the Amis and Jakob method on the tibia. Intra- and inter-observer reliability were evaluated with intra-class correlation coefficient (ICC).
Results
A radiographic analysis was completed in all patients in a SB-group and in 27 in a DB-group (p>0.05). Intra-observer reliability was almost perfect on femoral (ICC: a=0.85, b=0.83) and tibial (ICC=0.87) side in the SB-group. In the DB-group, it was almost perfect for tibial anteromedial (AM) and posterolateral (PL) bundles (ICC: AM=0.84, PL=0.81) and for femoral PL bundle (ICC: a=0.83, b=0.82), and substantial for femoral AM bundle (ICC: a=0.78, b=0.74). Inter-observer reliability was almost perfect on tibial (ICC=0.81) and femoral (ICC: a=0.81, b=0.87) side in the SB-group, and substantial on tibial (ICC: AM=0.71, PL=0.77) and femoral (ICC: AM a=0.73, b=0.78; PL a=0.74, b=0.76) side in the DB-group. Standard deviation (SD) was low (±9%) with respect to the centre of tunnel(s).
Conclusion
The quadrant method and the Amis and Jakob method are accurate and reproducible measurement methods. Also, as SD
was low, an outside-in approach with a front-entry guide, which is free-hand positioned, can be postulated as a reliable method to locate the femoral tunnel in SB reconstruction and the AM bundle in DB reconstruction.
Single use instruments for total knee arthroplasty
Authors: Romeo Michele , Rovere Giuseppe , Stramazzo Leonardo , Liuzza Francesco , Meccariello Luigi , Maccauro Giulio , Camarda Lawrence
Published: April 2024

Aim
Total knee arthroplasty represents a procedure that is successfully performed to relieve functional limitation and pain in advanced stages of osteoarthritis. In the next 20 years the number of these procedures will be increased about four times. Patient specific instrumentation (PSI) has been introduced in the past years. The aim of this study was to evaluate whether SUI are more useful in clinical, organizational and economic terms.
Methods
A database search about single use instrumentation (SUI) was conducted on PubMed and Google Scholar for the period 2010-2020 using the following key “total knee replacement”, “total knee arthroplasty”, “single use instruments”, and “disposable instruments”. The results of the selected studies were classified according to clinical, economic and organizational criteria.
Results
The main advantage of SUI has been reported to reduce costs, timely turnover of operating rooms, maximizing the operating room utilization and patient throughput, improving the number of outpatient total joint replacements. No difference has been found other than with regard to conventional instruments in terms of clinical outcome such as hip-knee-ankle angle and other radiographic parameters, Oxford Knee Score, while a decreased infection rate has been demonstrated. Regarding the economic aspect, a reduction of direct and indirect reduction of costs has been shown
for the cost of instruments reprocessing, tray sterilization, 90-day infection rate.
Conclusion
The SUI can be an alternative to conventional instruments, but there are still few studies in the literature regarding clinical outcomes.
A measurement of irradiance of light-curing units in dental offices in three Croatian cities
Authors: Dundić Ante , Rajić Brzović Valentina , Vlajnić Gloria , Kalibović Govorko Danijela , Medvedec Mikićo Ivana
Published: April 2024

Aim
To determine irradiance of light-curing units (LCUs) in dental offices in three Croatian cities and to compare irradiance values with the age and model of LCUs.
Methods
Private and public dental offices in three most prominent cities in Croatia (Rijeka, Split and Zagreb) were included in this
study. In total, 195 LCUs were tested, using radiometer Ivoclar Bluephase Meter 2 for irradiance (mW/cm2
). The minimum acceptable value was set at 400 mW/cm2. The age, model and difference between declared and measured irradiance of the LCUs were also determined. Of the total of 195 LCUs, 190 (98%) were LED (light-emitting diode) and 5 (2%) were QTH (quartz-tungsten – halogen).
Results
The mean age of tested LCUs was 4.43±3.4 years; the oldest was in Rijeka, 5.2±3.8 years. The overall mean irradiance
for all three cities was 806.4 mW/cm2 (p=0.0004). Of all LCUs, 11.3% were considered clinically unacceptable with irradiance of less than 400 mW/cm2. Of all tested LCUs 42% (p=0.0005) had a 30% lower value of irradiance than the manufacturer of the LCU declared. In 73% tested LCUs, there was a matching between measured and declared irradiance. The age and model of LCUs had the most significant impact on irradiance.
Conclusion
The most commonly used LCU included in dental offices was LED. Mean irradiance was good enough to secure
adequate polymerization of resin-based materials. Irradiance decreases with usage time of LCU. 
Intra-operative local plus systemic tranexamic acid significantly decreases post-operative bleeding and the need for allogeneic blood transfusion in total knee arthroplasty
Authors: De Falco Lidia , Troiano Elisa , Cesari Martina , Aiuto Pietro , Peri Giacomo , Nuvoli Nicolò , Fortina Mattia , Mondanelli Nicola , Giannotti Stefano
Published: April 2024

Aim
 To evaluate the efficacy of systemic plus local tranexamic acid (TXA) in reducing post-operative bleeding, haemoglobin loss and the need for allogeneic blood transfusion (ABT) in total knee arthroplasty (TKA).
Methods
All patients undergoing TKA between January 2017 and September 2019 were retrospectively evaluated. Exclusion criteria were cardiovascular comorbidities, diabetes and the assumption of any anticoagulant/antiaggregant therapy in the pre-operative period. All patients received the same prosthesis with the same surgical technique and were operated on by the same surgeon. Twenty patients were found (group A) that received intra-operative TXA (20 mg/kg intravenous 10 minutes before deflating tourniquet and 1g intra-articular after capsular suture). A control group of 26 patients not receiving TXA was matched for demographics (group B).
Results
Two (10%) patients in group A and 16 (61.5%) in group B needed ABT in the post-operative period (p=0.0004). Each patient in group A received 2 red blood cells (RBCs) units, while in group B 2 patients received one RBCs unit and one patient 4 RBCs units, for a total of 4 and 32 RBCs units in group A and B, respectively (p=0.0006). The minimum haemoglobin level was observed at 48 hours post-operatively in both groups: mean decrease was 3.54 and 4.64 g/dL in group A and B, respectively (p=0.0126).
Conclusion
The association of systemic and local TXA administration seems to significantly reduce post-operative bleeding and
the need for RBCs transfusions after TKA in patients not assuming any anticoagulant / antiaggregant therapy and without cardiovascular and diabetic morbidities.
Traumatic bilateral scaphoid fractures
Authors: Ghargozloo Dariush , Tomarchio Alessandro , Ballerini Mauro , Chitoni Gianpaolo
Published: April 2024

Aim
To illustrate the surgical treatment of bilateral post-traumatic scaphoid fracture.
Methods
We came across a young student, who sustained bilateral, undisplaced scaphoid waist fractures following a fall during a
football match. Despite careful clinical and radiographic evaluation by four views at the Accident and Emergency (A&E) Department, we initially performed only the diagnosis of the left scaphoid fracture treating it with a percutaneous Acutrack headless screw. Eight months later this patient returned to the A&E department due to a new trauma to his right wrist with the onset of painful symptoms: cystic scaphoid non-union. No pain had been reported on the wrist in those months.
Results
We performed osteosynthesis with Herbert headless screw through an extended volar approach placing a non-vascularized cortico-spongious bone grafts taken from radius. Periodic follow up by clinical examination, X-ray and CT scan with evidence of bone healing was performed.
Conclusion
Bilateral scaphoid fractures are rarely encountered, mostly as stress fractures in athletes and manual workers. If left untreated, arthritis, deformity, and instability can lead to significant disability. Comprehensive imaging should be done
in case of suspected scaphoid fractures, especially after a trauma, even in the presence of modest symptoms, as failure to do so may lead to missed fracture. Considering what was exposed, the radiographic check on the right wrist repeated about two weeks after the trauma would have avoided a missed diagnosis, even in the absence of reported clinical symptoms. We therefore recommend to repeat the radiographic examination in all situations like these.
Mortality associated with seasonal changes in ambient temperature and humidity in Zenica-Doboj Canton
Authors: Sivić Suad
Published: April 2024

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.
Comparison of early and delayed lumbar disc herniation surgery and the treatment outcome
Authors: Hadžić Ermin , Splavski Bruno , Lakičević Goran
Published: April 2024

Aim
To evaluate the influence of preoperative symptoms duration on surgical outcome of one-level lumbar disc herniation surgery.
Methods
 In a prospective randomized study, 67 adult patients with one-level lumbar disc herniation were analysed. The patients
whose duration of symptoms was <6 months were included in the case group, while those with the duration of symptoms ˃6 months formed the control group. The investigated preoperative variables were: pain intensity in the back and legs (Visual Analogue Scale - VAS), Sciatica Bothersomeness Index (SBI), index of disability (Oswestry Disability Index - ODI). Postoperative variables were: pain intensity in the back and legs (VAS), SBI, ODI, and outcome according to the Odom’s criteria (excellent, good, satisfactory and poor). Significance level was set at p <0.05.
Results
A statistically significant difference was recorded between the groups, showing a better decrease of radicular pain intensity
and sciatica bothersome, as well as patients disability in the case group (p<0.001). According to the Odom’s criteria the outcome was better in the case group, since the difference between the groups was statistically significant too (p<0.05).
Conclusion
Early lumbar disc herniation surgery performed within the first 6 months from the start of symptoms is beneficial due to decreases of radicular pain intensity, sciatica bothersomeness, and patient’s disability. 
Risk of surgical site infections after colorectal surgery and the most frequent pathogens isolated: a prospective single-centre observational study
Authors: Panos George , Mulita Francesk , Akinosoglou Karolina , Liolis Elias , Kaplanis Charalampos , Tchabashvili Levan , Vailas Michail , Maroulis Ioannis
Published: April 2024

Aim
To identify risk factors for developing surgical site infections (SSIs) based on a prospective study of patients undergoing colorectal surgery.
Methods
Between November 2019 and January 2021, 133 patients underwent elective operation for colorectal cancer in our institution. The following variables were recorded for each patient: age, gender, body mass index (BMI), American Society of Anesthesiologists Classification (ASA class), duration of surgery, wound classification, skin preparation regimens, surgical approach, comorbidities (hypertension, diabetes, cardiovascular disease, respiratory disease, chronic steroid use), and pathogens responsible for surgical site infection. Univariate analysis was performed using χ2 tests for categorical variables.
Results
A total of 65 males and 68 females were enrolled. Postoperative SSI was diagnosed in 29 (21.8%) cases. Fifty five patients were >70 years old, and SSIs were significantly more frequent in this group (p=0.033). There were 92 patients with BMI <30kg/m2 and 87 with ASA class ≤2; SSIs occurred significantly less frequently in these patients (p=0.021 and p=0.028, respectively). Open surgery was performed in 113 patients; 35 (out of 113; 31%) wound infections were classified as contaminated or dirty, and SSI occurred more often in these two groups (p=0.048 and p=0.037, respectively). Nineteen patients had diabetes and 36 used steroids continuously; SSI was significantly more frequent in these patients
(p=0.021 and p=0.049, respectively).
Conclusion
Following colorectal cancer procedures SSIs were significantly more common among patients over 70 years old,
BMI≥30kg/m2, ASA score>2, with diabetes and chronic steroid use, undergoing open, dirty or contaminated surgery. Escherichia coli and Enterococcus spp. were the two most common pathogens isolated.
Early predictors of severity and mortality in COVID-19 hospitalized patients
Authors: Mustafić Sehveta , Jusufović Edin , Hukić Fatima , Trnačević Emir , Divković Anja , Trnačević Alma
Published: April 2024

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.
Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications?
Authors: Sofić Amina , Rašić Ismar , Halilović Emsad , Mujić Alma , Muslić Denis
Published: April 2024

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.
Regulation of the apothecary activity in Bosnia and Herzegovina over the Austro-Hungarian period
Authors: Marković-Peković Vanda
Published: April 2024

Aim
To present the regulations governing the operation of pharmacies in Bosnia and Herzegovina over the Austro-Hungarian rule (1878-1918).
Methods
Qualitative secondary data analysis was used.
Results
The Austro-Hungarian government had found poor population’s health, insufficient health facilities and qualified staff.
For a long time, population was treated by old methods of medicine and pharmacy, and directed to folk doctors, healers and herbalists. As early as 1879, orders requesting mandatory possession of a university diploma to practice pharmacy and medicine, thus taking the initial steps to combat quackery. The production and dispensing of medicines became the exclusive competence of pharmacists. The Law on Pharmacies adopted in 1907 comprehensively regulated the apothecary activity. Pharmacy Gremium was founded, the first association of pharmacists with the task of protecting professional interests. All types of quackery were explicitly forbidden to pharmacy staff. Apothecary activity was regulated as a craft, not as a health activity. During this period, pharmacy became a regulated profession with educated and qualified personnel. The number of public pharmacies and qualified staff was growing. In 1878 only one
graduated pharmacist was found, while in 1910 in 47 pharmacies there were 79 pharmacy staff. At the end of 1918, the masters of pharmacy were the owners of 48 pharmacies, in 38 cities.
Conclusion
All enacted regulations contributed to the development and improvement of the apothecary activity over the observed period, and laid the foundations for the future development of the profession. 
The role of aripiprazole in improvement of penile erection in schizophrenia patients with erectile dysfunction
Authors: Handayati Harahap Debby , Raymondalexas Marchira Carla , Nurwening Solikhah Eti , Moch Rizal Dicky
Published: April 2024

Aim
To provide evidence regarding the effectiveness of aripiprazole in improving penile erection with a therapeutic strategy of
add-on or switching therapy in patients with schizophrenia.
Methods
PubMed, Cochrane, Clinical Key, ProQuest, EBSCOhost, and ScienceDirect were searched for any design study that
evaluated aripiprazole only or versus control (placebo or other antipsychotic) for erectile dysfunction in patients with schizophrenia. Three studies were identified and analysed from 295 initial articles. Data were then extracted from the studies and summarized descriptively.
Results
Two hundred ninety-five articles were screened, and three studies were identified and eventually selected. After the add-on or switching antipsychotic therapy to aripiprazole, the prevalence of erectile dysfunction and the score of erectile dysfunction or penile erection assessed by Nagoya and Sexual Function Questionnaire (NSFQ) and Arizona Sexual Experience Scale (ASEX) decreased.
Conclusion
Aripiprazole was effective to improve penile erectile function in patients with schizophrenia. The therapeutic strategy is
adjunctive treatment or switching therapy to aripiprazole.
Factors related to anxiety among resident doctors assigned to emergency room during the COVID-19 pandemic: a multivariate study at Sumatera Utara Affiliated Teaching Hospital
Authors: Effendy Elmeida , Selian Ariwan , Siagian Julius Martin
Published: April 2024

Aim
To evaluate and assess knowledge and perception, as well as factors related to the occurrence of anxiety among frontliners,
especially resident doctors working in emergency room (ER).
Methods
This multivariate study was conducted with cross-sectional approach involving 80 eligible subjects (based on inclusion
and exclusion criteria) that are consecutively assigned and assessed with GAD-7 questionnaire. The study was held in ER of Universitas Sumatera Utara affiliated teaching hospital from May to August 2020.
Results
Our study found that variables such as nuptial status (p=0.032), seniority level (p=0.037), history of direct exposure to COVID-19 patients (p=0.001) and weekly work duration (p=0.002) were all statistically significant to correlate with the
occurrence of anxiety among resident doctors assigned to work in ER.
Conclusion
Acknowledgement of these factors might lead to proper and targeted support system strategies to address the anxiety
issues among doctors, particularly those who work in ER during COVID-19 pandemic.
Neurocysticercosis with symptomatic epilepsy manifestation
Authors: Nekrasova Nataliya , Tovazhnyanska Olena , Sushetska Daryna , Markovska Olena , Shapkin Anton , Singh Rhea , Soloviova Yevhenija , Butov Dmytro
Published: April 2024

Aim
 To present a unique case of a 22-year-old male patient with symptomatic epilepsy manifestation on a background of neurocysticercosis (NCC).
Methods
An Indian student in Kharkiv, who lived in rural parts in India, presented with sudden episodes of seizure followed by severe headaches. Laboratory analyses and neurological status (MRI) were performed.
Results
 Neurological status of the patient revealed nystagmus and difficulty in performing coordination tests. General analysis of blood showed raised eosinophil count to 8%. The MRI showed a few small conglomerating peripherally enhancing thick-walled infective granulomas in left frontal lobe with extensive surrounding oedema in the left fronto-parietal lobe. The patient was treated with albendazol, levipil, methylprednisolone and pantoprazole. Clinical symptoms and subsequent MRI showed improvement.
Conclusion
 Neurocysticercosis is often misdiagnosed in the early stages, which leads to adverse outcomes. Although seizures are the most common clinical manifestation, it is a symptom that is not found in majority of the patients. The NCC of adult onset accompanying epileptic seizures is not well studied and a link between the helminthic invasion, epilepsy and psychiatric conditions needs to be established. This disease is potentially eradicable with wellplanned eradication programs targeting all stages of Taenia solium life cycle.
Assessment of mothers’ satisfaction with health care during childbirth in a tertiary-level maternity ward
Authors: Haller Adriana , Haller Albert , Tirić Dejan , Tomić Vajdana
Published: April 2024

Aim
To evaluate satisfaction of mothers who gave birth at term with received hospital care and to find areas for improvement at a tertiary hospital.
Methods
A cross-sectional study at the Department of Obstetrics & Gynaecology at the University Clinical Hospital Mostar was
conducted by an anonymous survey using a questionnaire designed exclusively for this study. A total of 100 mothers were included in the study.
Results
Satisfaction with midwives’ communication and their approach to the women during their stay in the delivery room
was rated significantly higher (4.7±0.6) when compared to obstetricians-gynaecologists (4.5±0.8) (p=0.02). Midwives were rated better in providing breastfeeding information (4.5±0.8) than for the speed of arrival after a call bell (average grade 4.2±1.0). Respondents were least satisfied with the hygiene (toilet, shower and rooms) and the quality of food (average grades 3.8±1.1 and 3.9±1.0, respectively). Mothers with previous experience in childbirth at the same hospital rated current stay with a similar level of satisfaction.
Conclusion
Good communication skills of medical and non-medical staff are a recommended step to maintain mothers′ childbirth
satisfaction, while improvement in quality of nutrition and hygiene should be mandatory.
Single-centre experience of emergency hernia surgery during COVID-19 pandemic: a comparative study of the operative activity and outcomes before and after the outbreak
Authors: Malik Adnan , Zohdy Mohamed , Ahmad Aftab , Seretis Charalampos
Published: April 2024

Aim
The outbreak of COVID-19 pandemic in January 2020 affected largely the elective operating for non-urgent surgical pathologies, such as hernias, due to periodical cancellations of the operating lists on a worldwide scale. To the best of our knowledge, the long-term impact of the COVID-19 pandemic in relation to the emergency hernia surgery operative workload and postoperative outcomes remains largely unknown.
Methods
Retrospective research of admission, operation and inpatient records of all patients who underwent emergency surgery
over a 2-year period (2019-2020) was done.
Results
An 18% increase in terms of emergency hernia surgery operating volume, with a 23% increase of visceral resections due
to unsalvageable herniated content strangulation was found. Overall morbidity did not increase during the pandemic period and there was no postoperative mortality or occurrence of COVID-19 related complications.
Conclusion
Emergency operative management of acutely symptomatic hernias can be safely performed even during the COVID-19
infection peak waves; hernia taxis should be reserved only for patients unfit or unwilling to undergo upfront surgery
Pregnancy outcomes of COVID-19 positive pregnant women at the Cantonal Hospital Zenica, Bosnia and Herzegovina
Authors: Hodžić Jasmin , Muračević Bedrana , Štimjanin Hana , Iriškić Rasim , Husika Muamera
Published: April 2024

Aim
To investigate clinical presentation of COVID-19 infection in pregnancy, its course during pregnancy, effects on pregnancy
outcomes for both mothers and newborns as well as the potential for vertical transmission.
Methods
This retrospective observational study included all identifi ed COVID-19-positive pregnant women admitted to the Cantonal Hospital in Zenica at any stage of pregnancy or labour from 30 April 2020 to April 30 2021. Maternity and newborns were
followed until discharge from the hospital.
Results
Twenty-four pregnant women were positive for COVID-19. There were 79.2% asymptomatic cases, 12.5% had mild
symptoms, while 8.3% had more severe forms of the disease. The main follow-up morbidities were high BMI 33.3%, anaemia 16.7%, thrombocytopenia 12.5%, hypertensive disorders 4.2% and diabetes 4.2%. The rate of premature births was 33.3%, while 8.3% pregnant women had premature rupture of the amniotic sac. Caesarean section was done for 75% women while 25% delivered vaginally. Previous caesarean section (54.2%) was the most common indication for operative completion of labour. Twentythree (92%) live babies were born, of which 8 (33.3%) were admitted to the neonatal intensive care unit. Two (8%) intrauterine foetal deaths were recorded that occurred before admission to our hospital. Two infants (8.7%) had a positive PCR test for COVID-19.
Conclusion
COVID-19 viral disease in pregnancy is usually presented as an asymptomatic or mild disease. It is associated with
high rates of preterm birth, admission of newborns to the intensive care unit and intrauterine foetal death. Vertical transmission is possible but the newborns were asymptomatic.
The effect of the shape of a clip on the magnetic field during magnetic resonance imaging examinations
Authors: Delibegović Samir , Batalović Mirza , Delibegović Mirela , Bujaković Tarik
Published: April 2024

Aim
Plastic clips are a diamagnetic material and produce fewer artefacts in the MR field than titanium clips, which are standard
in neurosurgery. However, alongside their physical properties, the shape of the clips, and their very geometry subtlety affects their behaviour in the magnetic field. Therefore, we performed a simulation in order to establish which clips cause less disturbance in the magnetic field from the point of view of the geometry of the body.
Methods
The simulation tool used for the research was the software package COMSOL Mph version 4.3. Since it was a question of
magnetics, the models were prepared in the AC/DC module within the option Magnetic Fields, No Currents (mfnc). Within this module we were able to analyse electro-magnetic fields for a specific geometrical structure, using the Finite Element Method in order to resolve the two-dimensional electromagnetic problems.
Results
The value of the magnetic field with titanium clips with their specific geometric reference lines reached the value of c.
(A/m). The simpler geometry of the plastic clips resulted in a less intensive magnetic field, amounting to c. (A/m), which is an entire order of magnitude less than the field with the titanium clips.
Conclusion
The simpler geometry of the plastic clips and the type of material from which they are made causes less disturbance to
the magnetic field, which was precisely confirmed with the simulation model. The use of plastic clips in neurosurgery and neuroradiology will facilitate the interpretation of MR images.
Rats’ umbilical-cord mesenchymal stem cells ameliorate mast cells and Hsp70 on ovalbumin-induced allergic rhinitis rats
Authors: Restimulia Lia , Ilyas Syafruddin , Munir Delfitri , Putra Agung , Madiadipoera Teti , Farhat Farhat , Sembiring Rosita Juwita , Ichwan Muhammad , Amalina Nur Dina
Published: April 2024

Aim
Allergic rhinitis (AR) is a heterogeneous condition that has been associated with inflammatory responses and is characterized by clinical typical symptoms of nasal itching, sneezing, watery discharge and congestion. Mesenchymal stem cells (MSCs) are multipotent stem cells that have the immunoregulatory ability by secreting various cytokines which potent as a promising therapeutic modality for allergic airway diseases, including AR. The aim of this study was to investigate the effect of rat UC-MSCs on the number of mast cells, the expression of Hsp70 indicated by the nasal symptoms allergic, particularly nasal rubbing in ovalbumininduced AR rats.
Methods
Fifteen male Wistar rats (6 to 8 weeks old) were randomly divided into three groups (control group, sham group, and
OVA+MSCs group). OVA nasal challenge was conducted daily from day 15 to 21, and UC-MSCs (1x106
) were administrated intraperitoneally to OVA-sensitized rats on day 21. Nasal rubbing was observed from day 22 to 28. The rats were sacrificed on day 22 and day 28. The nasal cavity tissues were prepared for histological observations.
Results
The administration of UC-MSCs could reduce the number of mast cells and the expression of Hsp70 leading to reduction of
nasal symptoms allergic, particularly nasal rubbing.
Conclusion
Based on this finding, MSCs present a promising immediate curative effect to the inflammatory reaction in AR rats.
Clinical efficacy of diazepam after whiplash: a randomized controlled study
Authors: Mešanović Edin , Habul Ćamil , Hadžić Ermin
Published: April 2024

Aim
To investigate the role of short-term diazepam therapy for improving long-term outcomes and reducing neck pain after whiplash injury.
Methods
A total of 89 patients suffering from whiplash injury were included. They were randomly assigned into 2 groups: group
A (study group), and group B (control group). The test group was prescribed with diazepam 5 mg tablets one time per day for 7 days and the control group did not get the recommendation to use diazepam. Three previously validated scales, Visual Analogue Pain Scale (VAS), the Neck Disability Index (NDI), and the Whiplash Disability Questionnaire (WDQ), were used at different intervals (7 days, 6 weeks and 6 months after the injury).
Results
Among 89 patients, 50 (56.2%) were males, 39 (43.8%) females. The mean age of all participants was 34.80±12.531 years. According to the Mann Whitney U –Test, no significant difference was observed in VAS, NDI, and WDQ scores between the control group and study group at any time point (p>0.05).
Conclusion
Diazepam provides no substantial advantage in the treatment of whiplash, and accordingly, we do not recommend diazepam therapy in patients who suffered whiplash injury. The trial was registered in the database of the Federal National Library of Medicine (NLM) (https://clinicaltrials.gov) under clinical trials (unique protocol ID:1703016).
Biochemical predictors of death before discharge in cooled newborns following perinatal asphyxia
Authors: Terzić Sabina , Vukas - Salihbegović Emina , Mišanović Verica , Begić Nedim
Published: April 2024

Aim
To analyse biochemical markers as possible predictors of death before discharge in cooled newborns following perinatal
asphyxia.
Methods
A total of 91 infants that underwent therapeutic hypothermia after perinatal asphyxia were included. Inclusion criteria for
therapeutic hypothermia were Sarnat stage 2 or 3. Data were collected from medical histories regarding gender, gestational age, birth weight, Apgar and Sarnat score; additionally, gas analyses, liver and cardiac enzymes before, and in the first 12 hours after starting therapeutic hypothermia, were evaluated. The patients’ characteristics were compared between two groups, survivors and non-survivors.
Results
Statistical difference was not found between groups regarding gender, gestational age, birth weight, delivery type, 1st and
5th minute Apgar score, seizures, alanine aminotransferase (ALT), creatine kinase (CK), troponin and fibrinogen level. Groups were significantly different regarding acid-base balance (p=0.012), base excess (BE) (p=0.025), lactate (p=0.002), aspartate aminotransferaze (AST), (p=0.011), lactate dehydrogenase (LDH) (p=0.006), activated partial thromboplastin clotting time (aPTT) (p=0.001) and international normalized ratio (INR) (p=0.001).
Conclusion
Acid-base balance, BE, lactate, AST, LDH, aPTT and INR were significantly higher in the group of cooled newborns
after perinatal asphyxia (non-survivors), and can serve as predictors of death before discharge. Combining diagnostic modalities raises a chance for accurate prediction of outcomes of asphyxiated infants.
High results and lower cost in four-bone arthrodesis with retrograde screws
Authors: Ghargozloo Dariush , Tomarchio Alessandro , Ballerini Mauro , Saccalani Emanuela , Grazioli Giorgio , Chitoni Gianpaolo
Published: April 2024

Aim
To describe the technique of the four-corner fusion with two retrograde crossed headless screws in cases of carpal collapse.
Methods
This technique is a consolidated procedure performed in cases of scaphoid non- union advanced collapse (SNAC) type
II and III, scapholunate advanced collapse (SLAC) type II and III and in other cases of carpal collapse. Between 2017 and 2019 we treated six male patients (a mean age of 55.0 years) with radiocarpal osteoarthritis. Our technique involves the use of two retrograde crossed headless screws; the first screw was placed distally proximally from the uncinate to the lunate and the second screw from the pyramidal to the capitate, crossed at approximately 90 degrees. Clinical and radiographic two-year follow-up was performed. Before the treatment and during the follow-ups VAS, PRWE
and DASH Quick score scales, measured wrist range of motion (WROM) were administered and evaluated.
Results
In all cases the X-ray consolidation of arthrodesis within five months was noticed; in 50% patients already under 3-month
control. No observed signs of mobilization of screws and inflammatory or infectious processes were found. All patients were satisfied (reduction/disappearance of pain). All surgically treated patients resumed normal daily activities. These improvements were confirmed by the results of the evaluation scale and clinical examination.
Conclusion
This technique, in our opinion, represents a gold standard. Its low costs of the material used (especially comparing to
other technique), a low prevalence of complications of materials and fusion in 100% of cases should be also considered.
Regulation of p53 and survivin by Curcuma longa extract to caspase-3 dependent apoptosis in triple negative breast cancer cells
Authors: Anggia Paramita Deryne , Hermansyah Dedy , Anggia Paramita Desiree , Amalina Nur Dina
Published: April 2024

Aim
Triple negative breast cancer cells (TNBC) are the population of breast cancer cells that are responsible for cancer recurrence and apoptosis resistance. Unfortunately, current therapies have limited efficacy to TNBC population due to apoptosis resistance and chemoresistance. Tumour suppressor p53 and survivin are primary targets for TNBC therapy. Consequently, a search for a natural compound which targets p53 and survivin is needed to further advance TNBC treatment. Curcuma longa extract (CL), a natural compound induces apoptosis in several cancer cells by targeting
various molecules and possess fewer side effects. However, a possible potential of CL as p53- and survivin modulating agent in TNBC cells has not been investigated.
Methods
MDAMB-231 cells were treated with several concentration of CL, after which, viability, p53 gene expression, surviving
protein expression, and caspase-3 protein expression were evaluated.
Results
After 24-h treatment, CL possessed cytotoxic effect with IC50 value of 13 μg/mL. Treatment with 1.625, 3.25, 6.5, and 13
μg/mL of CL resulted in 2.70-25.80% increase in caspase-3 expression levels followed by 94.60 – 21.60% decrease in survivin protein levels. CL induced remarkably p53 gene expression ratio up to 5-fold at 13 μg/mL. Survivin protein levels were inversely proportional to p53 accumulation levels. Low survivin protein levels combined with high levels of p53 accumulation were correlated to higher apoptotic rates.
Conclusion
p53 and survivin as molecular targets of CL contribute to caspase-3-dependent apoptosis in TNBC cells and this compound represents an attractive p53- and survivin modulating agent in TNBC.
A comparison of different doses of fentanyl for patients undergoing elective colonoscopy: a randomized double-blind clinical trial
Authors: Kovačević Mirza , Šabanović Adilović Adisa , Rizvanović Nermina , Adilović Harun , Ejubović Malik , Jahić Čampara Alma
Published: April 2024

Aim
To investigate analgesic and side effects of different doses of fentanyl in combination with propofol for colonoscopy.
Methods
This prospective randomized double-blind study conducted between 2019 and 2020 included 64 patients. Patients were randomized: Group 1 (fentanyl 0.5 μg/kg) and Group 2 (fentanyl 1.0 μg/kg) both in combination with propofol. Ramsay sedation score (RSS) was obtained at 5 with an additional dose of propofol. The primary outcome was the patient’s postprocedural pain and adverse events during and after the procedure.
Results
The RSS means were statistically lower for Group 2 at the beginning and every 5 minutes of the procedure. Mean arterial pressure (MAP) for Group 2 (first, 5, 25 and 30 min) was significantly lower (p=0.000, and heart rate (HR) was significantly higher for Group 1 (during the entire procedure) (p=0.000) than in another group; peripheral oxygen saturation (SpO2
) was significantly lower for measurements within both groups (Group 1, 5, 10, 15 min; Group 2, 5, 10,15 min) (p=0.000 and p=0.000, respectively). Anxiety (p=0.010), weakness (p=0.000) and confusion (p=0.023)
proved to be significantly higher for Group 1, and hypotension (p=0.001) for Group 2 than in another group. No statistical significance of Visual Analogue Pain Scale (VAS) (p=0.501) and Aldrete recovery score (ARS) (p=0.845) was found.
Conclusion
There was no significance in postprocedural abdominal pain between the group of patients administered fentanyl at a
dose of 0.5 μg/kg and the group of patients administered fentanyl at a dose of 1.0 μg/kg; however, prevalence of complications was more significant in the group with a fentanyl at a dose of 0.5 μg/kg.