Nasal carriage rate and antimicrobial resistance pattern of Staphylococcus aureus among the food handlers in Canton Sarajevo, Bosnia and Herzegovina

Introduction: The nasals and hand carriage of Staphylococcus aureus in food handlers (FHs) represent a significant source of Staphylococcal food contamination and food poisoning. Antimicrobial resistance (AMR) is a microorganism’s ability to resist the action of one or more antimicrobial agents. S. aureus has demonstrated the ability to rapidly respond to each new antimicrobial with the development of a resistance mechanism. The aim of the study was to assess the prevalence of nasal carriage rate and AMR pattern of isolated strains S. aureus among FHs in Canton Sarajevo, Bosnia and Herzegovina. Methods: The retrospective study included laboratory results of 11.139 tested subjects between January 2014 and December 2018. The study was conducted in the laboratory of the Institute of Public Health of the Federation of Bosnia and Herzegovina in Sarajevo. Samples of nasal swabs were collected from FHs, employees in companies located in Canton Sarajevo, during sanitary surveillance prescribed by applicable legal standards. S. aureus isolates were identified according to conventional microbiological methods and antimicrobial susceptibility testing was performed by the agar disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing; 2013 standard. Results: Among the 11.138 subjects, 792 (7.1%) were carriers of S. aureus. Isolated strains were tested on eight different antibiotics, and the resistance to penicillin, ampicillin, and amoxicillin was 788 (99.5%), 776 (97.9%), and 752 (94.9%), retrospectively. In total, 86.36% of isolated strains were multidrug-resistant. Conclusions: The low percentage of S. aureus carriers indicates that preventive measures of carrier control are being actively implemented within the legally prescribed measures. The emergence of numerous isolated strains with multidrug-resistance characteristics is a significant public health problem and consequently limits the range of antibiotics available for therapeutic purposes. The results of this research indicate that AMR has increased in Sarajevo Canton and it is following the trend of global growth

COVID-19 Pandemic: A Challenge for Healthcare Professionals and Assessment of Anxiety Symptoms

Introduction: Worldwide, COVID-19 pandemic caused millions of infected people and thousands of deaths. Due to enormous pressure on health-care systems and its inadequate preparedness, utter collapse is expected. In the current epidemic response, healthcare workers’ (HCWs) knowledge and practice are crucial, while the impact on their mental health is still unknown.Methods: The cross-sectional study was conducted among HCWs redeployed to COVID points in the Public Institution Health Centre of Sarajevo Canton. According to guidelines and information provided by the World Health Organization and Ministries of Health, a questionnaire was developed. In addition, General Anxiety Disorder-7 as a screening tool for anxiety disorders was used.Results: Of 180 respondents, 26 (14.4%) were in direct contact with the sick patient. In total, 79 (43.9%) respondents consider their personal protective equipment is in accordance with the guidelines of the world health authorities. A total of 72 (39.7%) of respondents used the same mask for several days. In general, the danger from new coronavirus was considered minimal by 59 (32,6%) HCWs. Based on the achieved score for assessing the anxiety disorder, in 63 (35%) subjects, the presence of severe symptoms was detected.Conclusion: This study found that most HCWs do not have enough knowledge about the COVID-19 pandemic. We identified that there are differences in the sources of information and gap in perceptions of the native origin of the virus. Considering the frequency of anxiety symptoms among HCWs, interventions are necessary in order to preserve their mental health

Poikilocytotic forms caused by hyperthermia and heat stroke- experimental study on Wistar rats

Background: The aim of the study was to find out what happens to erythrocytes and their forms during life and after death as a result of high water temperature.Methods: Heat stress was used on a rat model.to investigate the effects of different temperature intensities (37°C and 44°C) and exposure time (20 min and until the time of death) on erythrocyte morphology. Total of 23 Wistar rats were divided into two groups: 37°C as control group and 44°C as trial groups. The trial groups were classified into antemortem the exposure time of 20 min and postmortem groups exposure time until fatal outcome. The anaesthetised rats were exposed to preheated water using the water bath. May-Grünwald-Giemsa colouring technique was applied on blood samples taken from the abdominal aorta. Results: Exposure of Wistar rats to water temperature in groups KG37 and G44 led to a significant changes in core temperature. In the control group, the thermoregulatory mechanism established normothermia, and in G44 hyperthermia was detected during 20 minutes of exposure. The frequency of heat stroke in group G44 was 43.8%. Target cells and anulocytes were predominant in antemortem group at 44°C, while anulocytes and spherocytes in postmortem groups 44°C, respectively. Dacryocytes with spherocytes were significantly higher in postmortem group 44°C than in antemortem group 44°C (p=0.002, p=0.017, respectively).Conclusions: Poikilocytosis is associated with the exposure length and temperature intensity. Following a fatal outcome dacryocytes with spherocytes at 44°C were significantly more than in corresponding antemortem groups

Assessment of patient safety perception nurses in health system of Bosnia and Herzegovina in COVID period: Descriptive and cross-sectional study

Introduction: Patient safety depends on a number of factors such as teamwork, working climate, employee satisfaction, work environment, stress awareness, management perception, and attitude. Nurses have a key role to play in protecting and supporting patients, and their assessment serves as a reliable predictor of overall hospital safety. A positive attitude toward patient safety is associated with a significant reduction in complications. The aim of the study was to analyze the perception of nurses about all aspects of patient safety in relation to the workplace and length of service. Methods: The research included 647 nurses employed in health care institutions at the primary, secondary, and tertiary levels of health care. A descriptive and cross-sectional study included nurses from the Federation of Bosnia and Herzegovina. It was conducted in the period from November to December 2021, during the COVID pandemic. A standardized questionnaire on the perception of patient safety was used – Safety Attitudes Questionnaire – SAQ. Results: The analysis of the examined factors in relation to the workplace of the respondents revealed a statistically significant difference in job satisfaction (p < 0.001), as well as in the safety climate at work in relation to the workplace (p = 0.005), working conditions (p < 0.001), and management perception (p < 0.001). Stress levels showed significant differences regarding working position (p = 0.017), but also through the years of service (p = 0.012). Stress was significantly correlated with teamwork (r = 0.124; p = 0.003), showing that better teamwork will help with stress. Conclusion: The synthesis of concepts that includes patient safety and orientation toward patients should be implemented as a strategic quality orientation and set as a priority of every health care system

Increased mean platelet volume is associated with acute myocardial infarction in patients with diabetes mellitus type 2

Background: The correlation between diabetes mellitus and acute myocardial infarction is greater every day. The mean platelet volume (MPV), which is the determinant of platelet function, is an independent risk factor for the cardiovascular disease. The aim of the study was to investigate the effect of each disease (hypothyroidism, hypertension, myocardial infarction) individually and combined on MPV in diabetic patients.Methods: The cross-sectional study included 102 patients who suffer from diabetes mellitus type 2 (DMT2), of both sexes (46 females, 56 males), with the average age of 58.91 (SD=12.93). All the patients were treated at the Primary Health Centre in Zenica from May to July 2017. All patients had diabetes mellitus and the disease had lasted for 10 years in both sexes.Results: Mean platelet volume was significantly higher in patients with myocardial infarction than in those without myocardial infarction. Age, sex, HbA1c, BMI, lipids and platelet count did not show any significance in either group of patients. Regression analysis showed that the prevalence of myocardial infarction had the highest predictive significance for MPV values, (predictor importance 0.49; coefficient 1.275, p<0.001).Conclusions: Mean platelet volume was significantly higher in patients with diabetes mellitus and myocardial infarction than in DM patients without myocardial infarction. Regression analysis showed correlation with acute myocardial infarction in patients with DMT2, but not with other chronic illnesses. The highest platelet volume indices were observed in patients with myocardial infarction. MPV can be used as a specific indicator in diabetic patients with myocardial infarction.  

Risk assessment in biomedical laboratories – occupational safety and health aspects

Introduction: Laboratory personnel (LP) represent a high-risk group of healthcare workers for whom the primary laboratory environment and specific work activities are a major source of potential exposure to health hazards. This study aimed to evaluate the developed matrix and assess risk based on self-assessment. Methods: This multicenter, qualitative, and cross-sectional study was conducted on LP employed in biomedical laboratories. The respondents were divided into groups according to their territorial affiliation. The data collection tool used was a six-area questionnaire distributed online through a network of professional associations. For the risk assessment, a matrix was developed with scores ranging from 0 to 650, dividing the risk level into four categories. Descriptive and inferential statistical methods were used for the statistical analysis. Results: The developed model combined the classification of risk and risk factors with a certainty of p < 0.001. The regression analysis showed that working conditions had the greatest influence on overall risk, followed by physical, biological, and chemical hazards. Of the 640 respondents, the medium risk category was the highest in European Union (EU) countries (81.2%). Comparing the values in the high-risk category between the Bosnians and Herzegovinians (BiH) group and the Republic of Serbia, Republic of Northern Macedonia, and Montenegro (SCM) group with the EU group, a doubling (16.6%: 36.7%) and tripling (16.6%: 52.1%) of the proportion was found, respectively (p < 0.001). Overall, 1.7% of the LPs from BiH fell into the high-risk category. Conclusions: The designed matrix provides a reliable basis for identifying risk predictors in the study population and can serve as a useful tool for conducting risk assessments in biomedical laboratories. The results of the risk assessment indicate significant differences between the studied groups and highlight the need for increased control of BiH workplaces through new regulatory requirements

Canton Sarajevo journey through COVID-19 pandemic

Introduction: Sarajevo is the capital city of Bosnia and Herzegovina, with the population in Canton Sarajevo of 438,443 people. The first cases of COVID-19 in Canton Sarajevo were on 20th March. On that day, we had three positive cases. These days at the beginning of the COVID-19 epidemic in Canton of Sarajevo around 2500 citizens were in self-isolation at home. The aim of this paper is to show the journey of Canton Sarajevo in the fight against COVID-19 infection, the impact of measurements that were taken to stop the infection spreading and to compare pre- and post-lockdown stats.Methods: During the period March-July 2020, we have analyzed daily newly cases and followed them through the period of at least 14 days. All data were analyzed using SPSS 25.0 (IBM Corp. Released in 2019. IBM SPSS Statistics for Windows, NY: IBM Corp.) and MS Office 2019 suite (Excel). For comparison, we have used the Chi-square test.Results: In the period of 10 weeks from the beginning of March to the 25th of May in Canton of Sarajevo, we had a total of 113 cases of COVID-19 infection. The number of conducted tests was 7515. In total, with positive retests, we had only 161 positive tests, which is 2.14% of all analyzed tests. From that number of patients, 58 (51.3%) were male and 55 (48.7%) were female. Regarding age distribution, under 65 years were 91.1% of patients.Conclusion: Choosing the best method to fight against COVID-19 is hard to determine. Staying at home would decrease the infection rate, but in the long term, it is not sustainable. Perhaps the mix of methods that we had in Sarajevo is the best option. Fighting against one epidemic cannot be the source for other epidemics

Whether exercises and testosterone replacement therapy support a treatment for cardiovascular and atherosclerotic patients with iliac artery stenosis and low total testosterone and high-density lipoprotein cholesterol after endovascular procedure?

Serum levels of testosterone (ST) and high-density lipoprotein (HDL) are generally associated with atherosclerosis in male patients over 50 years with critic iliac stenosis (TASC II A and B) and cardiovascular disease with significant changes in HDL and low-density lipoprotein (LDL). In addition to the standard therapy, combined medicamentous therapy and adequate model of exercise are also important factors as medicines can improve HDL levels and primary bypass and endovascular potency impacting positively on improvement of ST or it can be the following testosterone replacement therapy (TRT) comprising cardiovascular disease prevention and vascular treatment as adjunct therapy options after endovascular and vascular surgical procedures. The aim of the study is to identify the association between HDL and ST after surgical and endovascular intervention on the iliac segment (TASCII A and B), as well as cardiovascular risk factors with modified medium activity (MET) 6 (MET), with total duration of 30–60 minutes. It also attempts to remodel a patient behavioral pattern, optimize ST levels and link them to outcomes and patency of vascular procedures on the iliac segment. Materials and methods. 108 selected male patients with cardiovascular disease combined with metabolic syndrome and critical iliac artery stenosis (TASC II A and B) were examined during 2014–2018, 4 years after invasive and minimal invasive treatment (54 patients were treated with surgical Dacron reconstruction and 54 patients – with endovascular treatment on short segment of critical iliac artery stenosis (TASC II A and B). Results. In the total population, no difference was observed in changes of constraint-induced movement therapy between the standard exercise group and the control one after 4 years from baseline. However, there was no significant interaction between the effect of exercise trainings and primary bypass potency within 4 years. Conclusions. Primary effects of endovascular procedure and Dacron bypass revascularization raise the risk of elevated testosterone levels after 4 years of group training but does not provide adequate answers to questions as to whether higher levels of ST have any major influence on primary bypass potency preventing further progression of cardiovascular disease and general symptomatic and asymptomatic atherosclerosis. However, exercise and TRT can be potential adjunctive therapeutic options for a future supporting postsurgical and endovascular illiac treatment in cardiovascular patients with low testosterone levels

Coronavirus disease 2019 (COVID-19): a new pediatric challenge

Coronavirus disease 2019 (COVID 19) is a pandemic disease that is today a global public health problem caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). COVID-19 is a disease of middle and old age, but clinical expression may also be present in childhood. Asymptomatic and mild clinical forms are most often present in persons aged 0-19, but severe clinical forms such as, among others, acute respiratory distress syndrome and multisystem inflammatory syndrome may occur. In addition to presenting the epidemiology, clinical symptomatology of COVID-19, the authors consider certain specifics of COVID-19, that is, possible reasons for the lower incidence of the disease as well as unusual and rare clinical forms of the disease in children. The current activities of health professionals in the supervision of COVID-19 are mainly focused on early detection, isolation and treatment of patients, isolation of contacts, the regular and thorough practice of respiratory hygiene, hand hygiene, and physical distancing. Future efficient and safe vaccination will solve the biggest global medical challenge caused by the new coronavirus in the best possible manner

Histological observations on adipocere in human remains buried for 21 years at the Tomašica grave-site in Bosnia and Herzegovina

The Tomašica grave-site near Prijedor in the north of Bosnia is reported to be the largest primary mass grave discovered thus far relating to the 1992–95 war. A total of 275 complete bodies and 125 body parts were exhumed from it in 2013. Post mortem examinations of the victims showed that nearly all had died from gunshot injuries but an additional striking feature was the degree of preservation of many of the bodies, even 21 years on, with skin, soft tissues and internal organs still present in abundance and gross structures clearly identifiable. Histology was performed on 68 samples of soft tissue from a total 13 bodies, on both skin and internal organs, and the degree of preservation was assessed in terms of the ability to recognize microscopic structure. Further comparison was made with samples taken a month or so later (56 tissue samples from 9 bodies, all but one different from the first group), after the bodies had been covered in salt as a means of general preservation. Generally, at a microscopic level, skin and subcutaneous tissues were better preserved than internal organs, while tissues sampled at the time of autopsy were better preserved than those sampled weeks later