bluuebunny/crossref_metadata_2025 huggingface dataset:
Tibial diaphyseal fractures in children: indications and limitations of the treatment with monolateral and hybrid external fixator
Authors: Bisaccia Michele , Rinonapoli Giuseppe , Di Giacinto Salvatore , Schiavone Andrea , Lazzeri Simone , Gomez-Garrido David , Herrera-Molpeceres Juan Antonio , Ripani Umberto , Ibáñez-Vicente Cristina , Rollo Giuseppe , Bonura Enrico Maria , Franzese Raffaele , Meccariello Luigi , Caraffa Auro
Published: April 2024

Aim
To report our indications and limitations about the use of external fixation in children.
Methods
It was retrospectively reviewed all tibial fractures treated with monolateral and hybrid external fixator, at our three Centres. It was included 32 fractures which did not show an acceptable reduction after an attempt under anaesthesia. The exclusion criteria were: open fractures, children with previous fractures of the lower limbs, with skeletal congenital diseases, fractures involving the physis and with neurovascular involvement. All fractures were classified according to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification. An outcome was evaluated according to the time needed to obtain radiographic bone healing, the range of motion (ROM) of the ankle, the asymmetry of the lower
limbs, the malunion, and complications.
Results
The average time of consolidation was 10.66 weeks (6-17 weeks). There were no cases of deep infection, but only seven cases of superficial pin infections. No patients reported loss of ROM of the knee or ankle. We had zero cases of residual angle greater than 5°, and in all cases the difference in length between the limbs
was ˂1 cm.
Conclusion
The external fixation is a viable technique in the treatment of tibial fractures in children. Therefore, the external fixation, both monolateral and hybrid, should be considered a viable treatment for this type of fracture.
Interleukin-8 heterozygous polymorphism (-251 T/A and +781 C/T) increases the risk of Helicobacter pylori-infection gastritis in children: a case control study
Authors: Supriatmo Dr , Alamsyah Siregar Gontar , Pahlevi Adeputra Nasution Iqbal , Ramayani Oke Rina
Published: April 2024

Aim
 To investigate the effects of interleukin-8 (IL-8)-251 T/A and +781 C/T polymorphism on the risk of Helicobacter pyloriinfection gastritis in children, and the IL-8 level of children with or without gastritis H. pylori infection according to polymorphism.
Methods
 This prospective, case control clinical study included 64 children 2-18 years old. A disease group (32 gastritis patients with H. pylori-infection) was compared with a control group (32 gastritis patients without H. pylori infection). Demographic characteristics of patients were taken by a questionnaire; gastritis was confirmed by gastroscopy, H. pylori infection was confirmed with rapid urease test. Serum IL-8 level was measured by ELISA, and IL-8-251 T/A and +781 C/T polymorphisms were analysed by RT-PCR. Demographic characteristics, IL-8 level, polymorphism of patients, and IL-8 level according to polymorphisms were compared between the groups.
Results
 Children with tobacco exposure were associated with an increased risk of H. pylori-infection gastritis by 3.4-fold. There was a higher IL-8 level in the disease group compared to the control group. The disease group with IL-8-251 AT polymorphism had a higher risk compared to TT polymorphism by 8.7-fold, and with IL-8 +781 CT polymorphism had a higher risk compared to CC polymorphism by 10.7-fold. Children in the disease group with IL-8-251 AT and TT, and +781 CT and CC polymorphisms produced a higher IL-8 level than the control group in respective polymorphisms.
Conclusion
 Children with H. pylori-infection gastritis have higher IL-8 production. There was an increased risk of developing H. pylori-infection in heterozygous-251 AT and +781 CT.
Characteristics of autologous peripheral blood stem cells collection over a one-year period
Authors: Ahmetović-Karić Gorana , Ćatović-Baralija Elma , Sofo-Hafizović Alma
Published: April 2024

Aim
 To present characteristics of collecting autologous peripheral blood stem cells over a one-year period with an emphasis on efficiency and safety.
Methods
A retrograde analysis of 24 leukapheresis in 20 adult patients with malignant haematological diseases in the Blood Transfusion Institute of the Federation of Bosnia and Herzegovina in Sarajevo, was done. Cell separators Amicus and Spectra Optia were used for collection procedures.
Results
The patient's age ranged from 27 to 65 years. Target cells were collected in one procedure in sixteen patients, while in four patients they were collected in two procedures. The mean CD34+ collection efficiency was 57.7%. The median number of CD34+ cells and percentage of CD34+ cells in the products were 5.52x10e6/kg (range 3.28-9.00) and 1.57% (range 0.96-2.91). A strong positive correlation was found between the number of CD34+ cells in peripheral blood on the apheresis day and the amount of CD34+ cells collected in the products (r s =0.73). A total of 95% of patients collected the amount of ≥3x10e6/kg and 55% of ≥5x10e6/kg CD34+ cells for a single transplant. A decrease in platelet count, haemoglobin and haematocrit values after the procedure was not significant. Potassium decrease showed statistical significance (p<0.000). Adverse events occurred during one procedure (4.2%).
Conclusion
 A low number of adverse events and good collection efficiency with adequate patient monitoring, indicate that leukapheresis is a safe procedure that is successfully used in the autologous transplantation process in the treatment of malignant haematological diseases.
Modalities of extensor tendon repair related to etiological factors and associated injuries
Authors: Salihagić Sanela , Zvizdić Zlatan , Hrustemović Dženana , Čaušević Redžo , Hemaidi Ahmad
Published: April 2024

Aim
To evaluate modalities of extensor tendons repair of hand and forearm in specific anatomical zones with regard to etiological factors and presence of associated injuries of adjacent anatomical structures.
Methods
This cross-sectional study included 279 patients referred for extensor tendon repair of hand and forearm in specific anatomical zones. Available treatment modalities were evaluated concerning etiological factors, anatomical zones, and associated injuries. Statistical significance was analysed in the occurrence of early and late postoperative complications according to anatomical zones.
Results
Direct repair of extensor tendon lesions was found to be the most common modality of reconstruction, 230 (93.5%),
of which blade injuries were predominant, 120 (48.7%). Direct tendon repair was mostly indicated in Zone VI and Zone III, in 55 (23.9%) and 42 (18.3%) patients, respectively. Statistically, a significant correlation was confirmed between treatment modalities, injuries in specific anatomical zones, and type of etiological factor (p<0.0001). Statistical correlation was confirmed between zones of injuries and the occurrence of early and late complications (p=0.002).
Conclusion
Successful postoperative recovery was correlated with the recognition of functional failure in specific zones, assessment of potential associated injuries, and selection of the most optimal modality of reconstruction.
Lifestyle risk factors and comorbidities of cancer patients in a country with limited resources
Authors: Mlačo Nejra , Šljivo Armin , Mulać Ahmed , Kurtović-Kozarić Amina , Pašić Anes , Bešlija Semir , Cerić Šejla , Cerić Timur
Published: April 2024

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.
Epidemiology of injuries connected with dance: a critical review on epidemiology
Authors: Rinonapoli Giuseppe , Graziani Marta , Ceccarini Paolo , Razzano Cristina , Manfreda Francesco , Caraffa Auro
Published: April 2024

The aim of this review was to identify all types of injuries connected to the gestures of dancers and understand the associated biomechanical patterns. This is the first step in the definition of a prevention program that lacks in this kind of athletic activity. A search of Medline/PubMed, EMBASE, and the Cochrane database from 1990 to 2019 using the search terms ‘‘dance and injuries’’ and ‘‘dance and injuries and epidemiology’’ initially resulted in 601 citations. A total of 16 articles were eligible for a review. All health problems that lead to stop the activity of a dancer are classified as "dancer's injuries". They were divided in acute and overuse injuries, the first being traumatic and the latter ones microtraumatic. The anatomical region most affected by injuries in dance was clearly the ankle and foot. It can be inferred that professional and
pre-professional dancers had a higher prevalence of back injuries in comparison to amateur dancers, while amateurs suffered more frequently from hip/groin/thigh injuries. Doctors, teachers, sport trainers and dancers themselves, all those who contribute to the dancer's performance, should know the most prevalent dancers’ injuries. Moreover, they should know the prevention procedures, in order to minimize the risk of injury and recurrences.
Male to female birth ratios over a 35-year period
Authors: Vraneš Hrvoje , Soljačić Vraneš Hrvojka , Djaković Ivka , Gall Vesna , Potkonjak Ana Meyra
Published: April 2024

Aim
Along with changes to the human physique recorded over the past decades in certain countries, there are also changes concerning the male-female birth ratio. The aim of this study was to establish the movement of male-female birth ratios and factors affecting the ratio.
Methods
This retrospective study was conducted in Zagreb, Croatia, in the period from 1985 to 2019 on a sample of 3804 newborns.
Results
In the 35-year period the ratio of boys and girls at birth did not change significantly. Girls had lower birth weight, and boys
had higher birth length. In the war period (1992-1994), a mild increase in the ratio of boys was noted, but not statistically significant. Father’s age in the last period examined (2007-2009) showed to be a statistically significant predictor of the child’s gender. Namely, the descendants of younger fathers were statistically significantly more frequently girls, while the descendants of older fathers were more frequently boys. Married mothers had higher percentage of male births (51.5%), and a lower percentage (47.1%) by unmarried mothers.
Conclusion
The changes in birth ratios are particularly pronounced in different age and socioeconomic groups of parents nowadays when the growth of living standards is accompanied by significant changes of the human physique.
Clinical use of an analysis of oxidative stress and IL-6 as the promoters of diabetic polyneuropathy
Authors: Karahmet Emina , Prnjavorac Besim , Bego Tamer , Softić Adaleta , Begić Lejla , Begić Edin , Karahmet Esma , Prnjavorac Lejla , Prnjavorac Irfan
Published: April 2024

Aim
To investigate interleukin 6 (IL-6) values depending on duration of diabetes mellitus (DM) and evaluate possible correlation
with diabetic polyneuropathy.
Methods
The research study included 90 patients with DM divided into three groups (30 patients each) according to the duration
of DM: group A – patients who had DM for less than 10 years, group B - duration of DM was 10 to 20 years, and group C - patients with DM over 20 years. Control group (K) included 30 healthy participants.
Results
IL-6 was significantly higher in the healthy control group, 180.318 pg/mL±94.18, than in group A, 47.23pg/ml±34.8, group B, 43.31pg/ml±33.17, and group C, 70.39 pg/ml±59.26 (p=0.0001). All groups had significantly different values of IL-6 between each other (p=0.0001). Level of IL-6 was in correlation with diabetic polyneuropathy in the group A (the youngest participants) (p=0.0001). In other groups there was no significant correlation between IL-6 and diabetic polyneuropathy.
Conclusion
 The level of IL-6 was in correlation with neuropathy among younger patients. A higher level of IL-6 in the control group
than in diabetic groups is a sign of stronger inflammatory response among younger and healthy people than in patients with DM. 
Minimally invasive sinus tarsi approach in Sanders II-III calcaneal fractures in high-demand patients
Authors: Ceccarini Paolo , Manfreda Francesco , Petruccelli Rosario , Talesa Giuseppe , Rinonapoli Giuseppe , Caraffa Auro
Published: April 2024

Aim To evaluate if the sinus tarsi approach treated with open reduction and internal fixation (ORIF), without using plate fixation, provided good functional results in active adult population. The hypothesis was that the sinus tarsi approach with limited incision provided good results comparable to other approaches. Methods A total of 78 patients (81 feet) surgically treated for articular calcaneus fracture were reviewed according to inclusion criteria: Sanders fracture type II-III, minimum follow-up of 2 years, patients aged 18-65 years. Exclusion criteria were smokers, diabetics, non-collaborative patients and patients with Sanders fracture type I and IV. A mean follow-up was 52.6 months. Radiographic changes of the Bohler's angle were reported. For the clinical evaluation, Visual Analogue Scale (VAS) for calcaneal fractures, American Orthopaedic Foot and Ankle Society (AOFAS) score and Maryland Foot Score (MFS) were used. Results A statistically significant restitution of Böhler's angle from preoperative to postoperative (13.5°-27°; p<.001) was found. The AOFAS and MFS showed pain relief and good/excellent functional activities at the final follow-up in 65 of 78 (83.3%) patients. In eight (out of 81; 10%) feet a superficial wound infection was observed. In three (3.8%) patients a subtalar arthrodesis was performed. Conclusion The mini-invasive sinus tarsi approach for active adult population is a valid and reproducible technique with a low rate of major complications, but it is mandatory advice to patients regarding the expectation of the results.
Correlation of signal to noise ratio (SNR) value on distortion product otoacoustic emission (DPOAE) and expression of nuclear factor erythroid 2-related factor 2 (NRF2) in cochlear organ of Corti in rat exposed to noise
Authors: Amellya Diana , Hajar Haryuna Tengku Siti , Riawan Wibi
Published: April 2024

Aim
To investigate the changes in the value of the signal to noise ratio (SNR) and to assess changes in the expression of nuclear factor erythroid 2-related factor 2 (NRF2) in the organ of Corti of rat exposed to noise.
Methods
This study used a randomized post test only control group laboratory experimental design with 27 male Wistar strain Rattus norvegicus. The study group was divided into 3 groups (n = 9): group I (control), group 2 (2 hours of 100 dB noise exposure) and group 3 (2 hours of 110 dB noise exposure).
Results
There was no significant difference in the SNR in the group 1 on day 0, 2 and 4 (p>0.05). However, there was a significant
difference in the SNR in the group 2 and the group 3 on day 0, 2 and 4 (p<0.05). There was a significant difference in the mean levels of NRF2 expression in the cochlear organ of Rattus norvegicus in all groups (p<0.05). There was no correlation between the SNR and the NRF2 expression in group 2 (p> 0.05), but there was a correlation between the SNR and the NRF2 expression in the group 3 (p<0.05).
Conclusion
There was found a correlation between the SNR value on distortion product otoacoustic emission (DPOAE) examination
and NRF2 expression in the cochlear organ of Corti of Rattus norvegicus exposed to 110 dB noise.
Biological augmentation strategies in rotator cuff repair
Authors: Özdemir Erdi , Karaguven Dogac , Turhan Egemen , Huri Gazi
Published: April 2024

Rotator cuff tears (RCT) are a common problem encountered by orthopaedic surgeons. The incidence of re-tears (up to 94%) following surgical repair of RCTs renders the management of RCTs challenging. This higher re-tear rate has been attributed to the failure of healing at the tendon-bone junction. Biological augmentation methods such as growth factors, stem cell therapies, and biomaterials have been developed to promote the healing at the tendon-bone junction. Growth factors and stem cell therapies have been intensively studied in mid to large RCTs. Biomaterials have been generally utilized for large or massive RCTs. However, these newly generated biological augmentation strategies are mostly studied in animal models. The efficacy and safety of the biological augmentation methods in humans need further investigation. In this review, we aimed to highlight the most recent advancements in RCT surgical repair with biological augmentation.
Medial pivot vs posterior stabilized total knee arthroplasty designs: a gait analysis study
Authors: Bianchi Nicola , Facchini Andrea , Mondanell Nicola , Sacchetti Federico , Ghezzi Roberta , Gesi Marco , Capanna Rodolfo , Giannotti Stefano
Published: April 2024

Aim
To compare a medial pivot (MP) total knee arthroplasty (TKA) with posterior stabilized (PS) TKA designs from a subjective, clinical and biomechanical point of view, in a single-centre, single-surgeon, case-control non-randomized trial.
Methods
Sixteen patients were randomly picked up from case series into each group. Subjective outcome was assessed using the
Forgotten Joint Score Questionnaire (FJSQ). Clinical evaluation included range of motion (ROM). All patients underwent gait analysis by a treadmill with force-measuring plaques and videorecording device; data were recorded for 30 seconds and included cadence, step length, stance time and walking speed. A blinded qualitative analysis of the pattern of gait was defined as biphasic or non-biphasic. Descriptive statistics for the continuous study variables and statistical significance were calculated for all parameters with independent-samples t-test and χ2 test to analyse difference in pattern of gait between groups.
Results
Mean FJSQ in the MP group was 91.87 (CI 95%: 88.12- 95.46) and 75.31 (CI 95%: 67.97-81.56) in the PS group (p=0.029). Mean post-operative ROM was 117° (CI 95%: 113°-122°) in the MP group and 112° (CI 95%: 108°-117°) in the PS group (p=0.14). No statistical difference was found between groups regarding all gait analysis parameters which have been recorded.
Conclusion
MP TKA design showed better subjective results using the FJSQ, but it did not improve significantly clinical and
functional outcomes compared to PS TKA design, at a short-term follow-up.
Arthroscopic labral repair with all-suture anchors: a magnetic resonance imaging retrospective study with a 2.5-year follow-up
Authors: Sacchetti Federico , Di Meglio Martina , Mondanelli Nicola , Bianchi Nicola , Bottai Vanna , Cartei Federico , Cosseddu Fabio , Capanna Rodolfo , Giannotti Stefano
Published: April 2024

Aim
To evaluate radiological and clinical outcomes of a case series of patients affected by glenohumeral instability (Bankart lesion) or superior labrum tear from anterior to posterior (SLAP) lesions treated by arthroscopic repair using all-suture anchors.
Methods
Patients were operated by a single surgeon at a single Institution. Exclusion criteria were chondral lesions of the glenoid,
rotator cuff lesions, previous surgery at the index shoulder, or a bony Bankart lesion. Position and numbers of anchors used depended on the dimension and type of lesion. The DASH (Disability of the Arm, Shoulder and Hand) and Constant scores were used for subjective and clinical evaluation at follow-ups (FUs); also, at  1-year FU, MRI scan was obtained to evaluate bone reaction to the implanted devices.
Results
 Fifty-four patients were included. A mean of 2.7 devices per patient (145 in total) were implanted. Mean FU was 30 (range 12 – 48) months. No patient reported recurrent instability, nor hardware-related complications were registered. MRI analyses showed that 119 (82%) implants did not alter surrounding bone (grade 0), 26 (18%) implants were surrounded by bone oedema (grade 1), while no bone tunnel enlargement nor a bone cyst (grade 2 or 3, respectively) were registered.
Conclusion
 This study confirmed the efficacy and safety of a specific all-suture anchor system in the arthroscopic repair of the glenoid labrum for glenohumeral instability or a SLAP lesion. In the short- and mid-term period, these devices were associated with good clinical and radiological outcomes without clinical failures or reaction at bone-device interface.
Balance assessment after altering stimulation of the neurosensory system
Authors: Li Causi Valentina , Manelli Alessandro , Marini Valentina Gianpaola , Cherubino Mario , Meccariello Luigi , Mazzacane Michael , Ronga Mario
Published: April 2024

Aim
Posture requires fine integrative elaboration, performed by the central nervous system, of neurosensory information originated from the visual, vestibular and spinal circuit. Many perturbing agents can influence this elaboration and then the postural stability. Several studies have evaluated only the effect of a single agent on the postural control. The study analysed the perturbing effect of several external agents on the different sensorial circuits in terms of postural balance loss in orthostatism.
Methods
 The postural stability of 31 patients was evaluated with a static posturography platform in basal conditions and after exposure to an external agent in the following order: stroboscopic light projecting, mechanical rotations on a swivel chair, feet desensitization through ice, administration of an alcoholic drink at intervals which depended on the participant return to basic posturographic values. Tests were performed with open eyes (OE), closed eyes (CE) and reducing plantar perception through the use of a rubber pillow.
Results
The stroboscopic light altered the postural control. The swivel chair disturbed only with CE. Ice and alcohol increased
the oscillation area. The alcohol test had a significant reduction in postural control with OE compared to CE. The rubber cushion increased the oscillation area in all OE tests and with CE in alcohol and ice tests.
Conclusion
The different agents did not trigger postural control deficits in the same way. A cold environment with psychedelic lights and the use of alcoholic beverages altered significantly the postural stability by influencing simultaneously all perceptions
(visual, vestibular and somatosensory feedback). 
Current status of localized submental fat treatment with sodium deoxicolate (ATX-101)
Authors: Ibáñez-Vicente Cristina , Carrato-Gomez Miguel , Meccariello Luigi , Ripani Umberto , Bisaccia Michele
Published: April 2024

Aim
Facial aesthetics is at present a concept intricately linked to the degree of self-esteem. Unwanted submental fat (SMF) leads to an unattractive submental profile. Sodium deoxicolate (ATX) -101 is the only injectable drug approved to decrease submental fat of moderate to severe intensity.
Methods
We carried out a bibliographic review in PubMed using the key words: deoxycholic acid, ATX-101, and submental fat.
Only complete articles published between 2009 and 2019, and focused on submental fat were reviewed, excluding those articles relating to that spoke of deoxycholate in the treatment of fat in other locations or in which deoxycholate was associated with other drugs.
Results
In several phase III clinical trials, injection of 2 mg/cm2 deoxycholic acid in SMF has reduced moderate-severe fullness compared to the placebo group. These results were maintained in most cases during a long follow-up period. Injections of
deoxycholic acid are generally well tolerated, with limited adverse effects in the treatment area, with a mild and complete resolution without sequelae. However, not all patients with SMF are suitable for deoxycholic acid therapy, and therefore a proper selection is very important to achieve the desired aesthetic results.
Conclusion
Deoxycholic acid injections are effective and are a generally well-tolerated, minimally invasive option for the treatment
of moderate to severe intensity SMF in selected adults.
Retinal changes in febrile seizures in children: a retrospective analysis in Tuzla Canton, Bosnia and Herzegovina
Authors: Halilbašić Meliha , Nadarević Vodenčarević Amra , Međedović Anis , Halilbašić Amir , Ćosićkić Almira , Pidro Ajla
Published: April 2024

Aim
To evaluate the possibility of retinal haemorrhages or any other retinal pathology caused by febrile seizures alone in children aged between 2 months and 15 years.
Methods
Children aged between 2 months and 15 years admitted to the hospital following seizures were examined within 48 hours
of admission. The seizures were classified by a paediatric neurologist and a detailed ocular examination, including indirect ophthalmoscopy, was performed by an ophthalmologist.
Results
In the period between May 2019 and May 2020 a total number of 106 children were examined. There were 66 (62.3%)
male and 40 (37.7%) female children. The youngest patient was 2 months old and the oldest patient was 15 years old. None of the children was found to have retinal haemorrhages or any other retinal pathology.
Conclusion
Retinal haemorrhages or any other acute retinal findings in children with febrile seizures are very rare, but we cannot
rule out its occurrence. The finding of retinal haemorrhages in a child admitted with a history of seizure should trigger a detailed search for other causes of those haemorrhages, especially shaken baby syndrome. Due to the lack of any manifestations on the retina after febrile seizure, maybe it is time that the current protocol and guidelines, considering obligatory fundus examination, should be re-examined
Reamputation stumps below knee
Authors: Shevchuk Viktor I. , Bezsmertnyi Yurii O. , Jiang Yankai , Bezsmertna Halyna V. , Dovgalyuk Tetyana V.
Published: April 2024

Aim
To investigate rehabilitation outcomes of patients with malformed tibial stumps.
Methods
Observations included 421 patients with residual limb diseases and malformations (extensive inactive scars adhered to
the bone, excessively long or short stumps, bone filing, osteomyelitis of the stump, muscle attachment to the skin scar, excessive mobility and deviations of the fibula, improper filing). Four hundred and thirty-six (436) reconstructive surgeries were performed. A follow-up period was from 6 months to 15 years. Radiological, ultrasonic, tensometrical, and histological methods were used.
Results
Due to the frequent combination of several malformations and diseases in the same patient, non-free skin grafting with
displaced dermal-subcutaneous flaps, which cover rather large defects, was widely used. The surgeries were performed simultaneously and allowed for reconstruction without shortening the bone lever stump. Complications in the form of marginal necrosis were obtained in three (0.71%) patients. The improved technique of muscle grafting with the fixation of muscles to the bone provided an elastic stump covering the bone filing. The authors have developed original methods of surgery to create a bone block of the tibia, which make it possible to obtain painless, highly functional stumps using partial support and ensure long-term use of modern prosthesis designs in 100% of cases.
Conclusion
Non-free dermal plasty with cutaneous-subcutaneous flap is the method of choice for closing skin defects on the residual limb. Muscle-bone fixation permits to eliminate some residual limb defects and to form an elastic muscular residual limb with closed bone filaments. Synostosis formation in different ways considerably improves functional quality of the residual limb.
Knowledge, attitudes and practices during the second wave of COVID-19 outbreak: a cross-sectional study from various perspectives
Authors: Šljivo Armin , Bhattacharyya Sutanay , Mulać Ahmed , Abdulkhaliq Arian , Rexhep Sahatçiu
Published: April 2024

Aim
To investigate knowledge, attitudes and practice towards COVID-19 among selected population.
Methods
An anonymous online questionnaire based on a Chinese study was distributed via online social media platforms among
general population of Bosnia and Herzegovina, Germany, India, Kosovo and Romania.
Results
In total 1032 subjects, predominately females, 615 (59.6%) with a mean age of 31.23±12.94 years, single, 705 (68.3%), with high school degree or lower, 469 (45.4%), students, 528 (51.1%) and living in an urban environment, 824 (79.8%), have completed the survey. The median knowledge score was 10.0 (range 0-12). Being male (β: -0.437; p=0.003) and older (β: -0.028; p<0.001) were associated with lower knowledge scores, while being single (β: 1.026; p<0.001) and mental labour employee (β: 0.402; p=0.032) were associated with higher knowledge scores. The vast
majority of subjects had not visited crowded places, 630 (61.0%) and wearing masks when they were going out, 928 (89.9%). Being female (OR=0.731; p=0.022), having higher knowledge scores (OR=0.929; p=0.017) and being a mental labour employee (OR=0.713; p=0.031) decreased the exposure to crowded places. High school or lower education level (OR=0.616; p=0.024) decreased the action of wearing a mask in public places, while higher knowledge scores (OR=1.112; p=0.013) increased it.
Conclusion
Our study suggests that residents of the selected regions have had good knowledge, pessimistic attitudes and relatively
appropriate practices towards COVID-19 during the second wave of the outbreak. 
Clinical characteristics, comorbidities and mortality in critically ill mechanically ventilated patients with Covid-19: a retrospective observational study
Authors: Šabanović Adilović Adisa , Rizvanović Nermina , Kovačević Mirza , Adilović Harun
Published: April 2024

Aim
To analyse demographic data, clinical symptoms and signs, laboratory data and comorbidities in patients with COVID-19 pneumonia admitted to the intensive care unit (ICU), mechanically ventilated with fatal outcome.
Methods
Medical records of 92 patients were retrospectively analysed. Demographic data, clinical symptoms and comorbidities
were collected on the day of hospital admission. Clinical signs and laboratory data were collected on the day of hospital admission (T1), on the day of starting non-invasive ventilation (T2), and on the day of starting invasive ventilation (T3).
Results
Average age of the patients was 60.05 years. Patients over 50 years of age, 71 (77.1%) (p=0.000), and males, 62 (67.4%;
p=0.001) were predominant. The most common patient symptoms were exhaustion, myalgia, dyspnoea and cough. Hyperthermia was recorded on the day of hospital admission. Tachycardia, hyperglycaemia, hypoxemia were recorded at all observed study times. The most common comorbidity was hypertension arterialis with a very strong correlation with fatal outcome, followed by diabetes mellitus and chronic heart disease that were moderately correlated with fatal outcome.
Conclusion
The treatment of COVID-19 patients in ICU with mechanical ventilation has a high failure rate. Demographic data,
clinical symptoms and signs as well as accompanying comorbidities can be a significant component in making decisions about diagnostic-therapeutic procedures.
Epidemiology of hospitalized patients with peripheral arterial disease in Bosnia and Herzegovina
Authors: Mlačo Akif , Mlačo Nejra , Mekić Mevludin , Džubur Alen
Published: April 2024

Aim
To investigate a profile of patients with peripheral artery disease (PAD) in Bosnia and Herzegovina.
Methods
This observational study included 1022 patients hospitalized at the Clinical Centre University of Sarajevo in a 5-year period, 2015 to 2019.
Results
Disease prevalence rises sharply after the age of 50. Most patients, 797 (78%) had proximal PAD; 658 (64.4%) were
males. The death occurred in 73 (7.1%) patients, more often in females (66- 10%), and in patients with chronic kidney disease (10- 23.8%). Amputation occurred in 153 (15%) patients, where 102 (66.7%) patients had diabetes. Other surgical procedures were more common in males and smokers. Necrosis and phlegmon on lower extremities were found in 563 (55.1%) and 43 (4.2%) patients, respectively. History of tobacco use was noted in 620 (60.2%) patients, and 414 (40.8%) patients were current smokers. More than a half of patients had hypertension and diabetes, 596 (58.3%)
and 513 (50.2%), respectively. One in 10 patients had a history of myocardial infarction or stroke. Most patients had high fibrinogen and blood glucose and low high-density lipoprotein (HDL).
Conclusion
Patients with PAD have multiple comorbidities and risk for various complications. Primary and secondary prevention
of risk factors is the mainstay of treatment.
Revealing the decrease of indoleamine 2,3-dioxygenase as a major constituent for B cells survival post-mesenchymal stem cells co-cultured with peripheral blood mononuclear cell (PBMC) of systemic lupus erythematosus (SLE) patients
Authors: Masyithah Darlan Dewi , Munir Delfitri , Putra Agung , Alif Iffan , Amalina Nur Dina , Karmila Jusuf Nelva , Putra Imam Budi
Published: April 2024

Aim
Mesenchymal stem cells (MSCs) have potent immunosuppressive properties to control systemic lupus erythematosus (SLE) disease by inhibiting indoleamine 2,3-dioxygenase (IDO), and increasing regulatory T cells (Treg) to control innate and adaptive immune cells. However, the interaction and mechanism regarding IDO and B cells in the co-culture of MSC and SLE peripheral blood mononuclear cell (PBMCs) remain unclear. This study aimed to investigate the effects of MSCs in controlling B cells through IDO expression in PBMC of SLE patients.
Methods
This study used a post-test control group design. MSCs were obtained from human umbilical cord blood and characterized according to their surface antigen expression and multilineage differentiation capacities. PBMCs isolated from SLE patients were divided into five groups: sham, control, and three treatment groups. The treatment groups were treated by co-culturing MSCs to PBMCs with a ratio of 1:10, 1:25, and 1:40 for 72 h incubation. The B cell levels were analysed by flow cytometry with cytometric bead array (CBA) and the IDO levels were determined by ELISA.
Results
The percentages of B cells decreased significantly in groups treated by dose-dependent MSCs, particularly in T1 and T2
groups. These findings were aligned with the significant decrease of the IDO level.
Conclusion
MSCs control B cells-mediated by a decrease of IDO in PBMC of SLE patients.
Lenticulostriate vasculopathy in routine brain ultrasonography in infants: next step?
Authors: Heljić Suada , Maksić Hajrija , Terzic Sabina
Published: April 2024

Lenticulostriate vasculopathy (LSV) is a relatively common fi nding in routine cranial ultrasound examination that has been associated with many infectious and non-infectious conditions. The aim of this review was to provide a better understanding of LSV ultrasound fi nding, as well as the need for further laboratory and imaging examinations in infants. The most of the published studies represented small series, with few prospective long-term studies involving the control groups. Authors have mostly found an association between LSV, especially higher-grade (although there is no universally accepted classifi cation) with congenital cytomegalovirus (CMV) infection, classifying those children as at risk for sensorineural hearing loss. In contrast, some authors pointed out that LSV could be found relatively often, and believe that isolated LSV, especially lower-grade, is not predictive for an unfavourable outcome and a long-term prognosis. Therefore, although 35 years
have passed since the fi rst publication of LSV, there is still no consensus among experts on the clinical signifi cance of isolated LSV, but caution is certainly needed given the fact that most infants with congenital CMV are asymptomatic.
Can neutrophil-to-lymphocyte ratio and proatherogenic risk factors improve the accuracy of pneumonia severity index in the prediction of community acquired pneumonia outcome in healthy individuals?
Authors: Mujaković Aida , Paralija Belma , Lepara Orhan , Fajkić Almir , Kurtović Avdo , Prnjavorac Besim , Begić Edin , Gondžetović - Ćorić Nejra
Published: April 2024

Aim
To investigate influence of neutrophil-to-lymphocyte ratio (NLR) and proatherogenic risk factors to improve the accuracy
of pneumonia severity index (PSI) in the prediction of community acquired pneumonia (CAP) outcome in healthy individuals.
Methods
A retrospective observational cross-sectional study conducted at the Clinic for Pulmonary Diseases and Tuberculosis “Podhrastovi”, University Clinical Centre Sarajevo, included 83 patients with the diagnosis of CAP during the period March
2019-March 2021. Once diagnosed with CAP, PSI score was calculated and according to its value the need for hospital treatment was identified. Patients were divided in two groups: low risk of CAP (PSI <90), and high risk of CAP (PSI> 90).
Results
The overall average hospital stay was 22.76±10.154 days. In the patients diagnosed with CAP, a positive correlation was
established between the following parameters PSI score and age (r=0.670; p<0.01), C-reactive protein-CRP (rho=0.287; p<0.01), leukocytes (rho=0.406; p<0.01), NLR (rho=0.313; p<0.01) and platelet to lymphocyte ratio (PLR) (0.296; p<0.05). CRP, leukocytes, NLR and PLR were statistically significantly higher in patients with high risk of CAP compared to patients with low risk of CAP. Diastolic blood pressure, lymphocytes, eosinophils were significantly lower in patients with high risk of CAP (p<0.05;) compared to patients with low risk of CAP (p<0.01). The optimal cut-off value of NLR for CAP patients was 3.089 with an estimated area under curve (AUC) of 0.664.
Conclusion
Proatherogenic parameters such as age, systolic blood pressure and leukocytes in combination with neutrophil-lymphocyte count ratio could improve accuracy of the pneumonia severity index in community acquired pneumonia outcome.
Pheochromocytoma in pregnancy – a rare but dangerous diagnosis
Authors: Marušić Romana , Olujić Marija , Bačun Tatjana
Published: April 2024

Pheochromocytoma is a rare cause of hypertension in pregnancy. Unrecognized, it carries a great risk for both mother and the foetus. The main reason for missing the diagnosis is the misconception that any hypertension occurring in pregnancy is gestational hypertension or pre (eclampsia). As many as 90% of patients report one or more pheochromocytoma-related symptoms antenatally, but the diagnosis is made in 75% of patients, meaning that 3 out of 10 patients are diagnosed after childbirth or post-mortem. The symptoms are similar to other more common causes of hypertension in pregnancy, which presents a major diagnostic challenge. The diagnosis is based on determination of metanephrines in plasma or 24-hour urine. Magnetic resonance imaging (MRI) and ultrasound (US) are used to localize the tumour. If the diagnosis is made before the 24th week of pregnancy, laparoscopic removal of the tumour in the second trimester is recommended. If diagnosed later, the tumour could be removed during or after delivery. Preoperative preparation with alpha blockers is required to stabilize blood pressure. The decision on the mode of delivery depends on several factors, so an experienced multidisciplinary team is needed to minimize maternal and foetal mortality.
Association between donor’s age and expression of cardiomyocyte marker quantity on adipocyte-derived mesenchymal stem cell
Authors: Fitriadi Bagus , Dharmadjati Budi Baktijasa , Budiarto Mohammad , Intan Ryan Enast , Alkaff Firas Farisi
Published: April 2024

Aim
Adipocyte-derived mesenchymal stem cells (AMSCs) have recently been studied as a potential new approach for regeneration treatment of heart failure and ischemic myocardium. However, donor’s age is thought to affect the ability of AMSC cells to differentiate into cardiomyocytes. This study aimed to analyse the association between donor’s age with the expression of cardiomyocyte marker cardiac isoform of Troponin-T (cTnT) quantity on AMSCs.
Methods
Subcutaneous adipose tissue was taken from donors of 3 different age groups (30-40, 41-50, and >50 years old), and
then processed into AMSC cells by insert culture. AMSC cell phenotype was identified by assessing the quantity of mesenchymal markers expression (CD34, CD45, CD90, CD105) using indirect immunofluorescence technique. Afterwards, cTnT expression, a marker for cardiomyocyte differentiation from AMSC cells, was evaluated under the fluorescent microscope. The comparison was done between the 3 different age groups.
Results
The comparative test and post hoc analysis showed that there were differences in the expression of CD34, CD45, CD90,
CD105, and cTnT between the three age groups (all p<0.05). Furthermore, there were strong negative correlations between age and CD34, CD90, CD105 and cTnT (r= -0.844, -0.914, -0.899, and -0.738, respectively), while the correlation was positive between age and CD45 (r=0.899).
Conclusion
Expression quantity of mesenchymal markers and cardiomyocyte markers from AMSC cells were affected by the
donor’s age. The higher the donor age group, the lower the expression quantity of mesenchymal markers (except CD45) and cTnT.
Obstetric shock and shock in obstetrics – steady obstetrical syndrome
Authors: Cerovac Anis , Habek Dubravko , Cerovac Elmedina , Čerkez Habek Jasna
Published: April 2024

Obstetric shock (OS) has been defined as a life-threatening cardiovascular collapse syndrome associated with pregnancy, childbirth and puerperium (obstetrics causes), and is the most significant cause of high maternal mortality (MM) throughout human history. Shock in obstetrics (SIO) refers to indirect causes of non-obstetrics causes in pregnancy, childbirth and puerperium (polytrauma, aesthetic incidents, cardiovascular or cerebrovascular incidents, other septic syndromes). The goals of OS treatment are: to quickly detect the location or cause of bleeding / injury / inflammation, prevent the progression of shock, prevent massive transfusions, preserve the uterus (and adnexa), and preserve fertility if possible. Surgical treatment of septic shock includes exploratory laparotomy (laparoscopy), ectomy or resection of the necrotized organ,
abdominal lavage with multiple drainages, continuous peritoneal drainage with lavation, extensive triple antibiosis per admission or per antibiogram and thromboprophylaxis. OS seems to remain a permanent miasma in practical clinical obstetrics, which we will not be able to influence, because we have obviously caused today's increase in MM from haemorrhagic OS by iatrogenic increase in the number of caesarean sections, especially elective ones.
Trends in stroke thrombolysis rate in Bosnia and Herzegovina: a hospital-based observation study
Authors: Bender Marija , Čović Stjepan , Baranik Matea , Lakičević Sandra , Klupka-Sarić Inge
Published: April 2024

Aim
To assess trends in thrombolysis rates and door-to-needle times in University Hospital Mostar.
Methods
Data from the University Hospital Mostar Registry were used. Information on the number of ischaemic stroke patients, intravenous thrombolysis rates and „door-to-needle times“ (DNT) were collected between January 2013 and December 2021.
Results
Out of the total of 3100 ischaemic stroke patients, alteplase was given to 130 patients giving a thrombolysis rate of 4.2%.
The mean hospital thrombolysis rate increased from 2.4% in 2013 to 10.6% in 2021.
Conclusion
Although the hospital thrombolysis rate more than quadrupled, there is still a low proportion of acute ischaemic stroke
patients who received intravenous thrombolysis therapy. Education and interventions indicating the importance of recognition and treatment of acute ischemic stoke are necessary for all physicians.
The role of mesenchymal stem cells in allergic rhinitis and its relationship with IL-10, plasma cells and regulatory T cells
Authors: Munir Delfitri , Pahlevi Nasution Iqbal , Restimulia Lia , Putra Agung , Amalina Nur Dina
Published: April 2024

Aim
Allergic rhinitis (AR) is an IgE-mediated inflammation of the nose. Regulatory T cells (Tregs), plasma cells and inflammatory cytokines have shown to play a critical role in allergic airway inflammation. The aim of the study was to investigate the role of mesenchymal stem cells (MSCs) in generating Treg cells and plasma cells associated with regulating interlukin-10 (IL-10) in AR model.
Methods
Fifteen male Wistar rats (6 to 8 weeks old) were randomly divided into three groups (control group, sham group, and
MSCs treatment group). Ovalbumin (OVA) nasal challenge was conducted daily from day 15 to 21, and MSCs (1x106
) were administrated intraperitoneally to OVA-sensitized rats on day 21. Sneezing was observed from day 24 to 27. The rats were sacrificed on day 24 and day 27. The expression of Treg and plasma cells was analysed by flow cytometry assay. The level of IL-10 was analysed under ELISA assay.
Results
This study showed that the percentage of sneezing and rubbing times significantly decreased in MSCs treatment associated with the regulation of IL-10 level and plasma cell. This finding was aligned with the significant increase of Treg level.
Conclusion
MSCs administration regulates IL-10 and plasma cell-mediated immune and inflammatory responses while increasing Treg cell production. MSCs may be a promising therapeutic target for treating Treg-mediated allergic diseases.
Efficacy of nebulized hypertonic saline versus normal saline in the treatment of acute bronchiolitis in inpatient infants
Authors: Bakalović Ganimeta , Jarkoč Tarik , Begić Nedim , Lepara Orhan , Bokonjić Dejan , Mihajlović Dušan , Pasić Amela , Fajkić Almir
Published: April 2024

Aim
Compare the efficacy of nebulized hypertonic saline and normal saline in the treatment of infants hospitalized for bronchiolitis.
Methods
This retrospective study was conducted at the Department of Pulmonology, Paediatric Clinic, Clinical Centre University of Sarajevo, covering the period from January 2015 to December 2019 and comprising 380 children aged between 1 and
12 months having bronchiolitis. One group received nebulized hypertonic saline (NHS, 3% NaCl)), and another group received nebulized normal saline (NNS, 0.9% NaCl). The control group did not receive any of these treatment options.
Results
There was no statistically significant difference between the treatment groups regarding length of hospital stay (LOS) and
Clinical Severity Score (CSS) at admission and discharge as well as in oxygen therapy duration and antibiotic use, the duration of symptoms before hospital admission, frequency of nasal discharge, elevated temperature, dyspnoea, cough and dehydration.
Conclusion
The results of this study are consistent with several recent studies or meta-analyses and support the evidence against the
use of NHS in hospitalized infants with mild or moderate bronchiolitis.