KNOWLEDGE AND ATTITUDES ON MANDATORY VACCINATION AMONG STUDENTS OF THE FACULTY OF HEALTH STUDIES OF THE UNIVERSITY OF MOSTAR

Introduction: Vaccination against infectious diseases is the most effective, cost-effective, often unavoidable, or the only possible way to protect individuals and the population from infectious diseases. In the last ten years, a lack of understanding and knowledge about the benefits of vaccination has led to a decline in the number of vaccinated children and the danger of the reappearance of already eradicated infectious diseases. Objective: To examine the knowledge and attitudes about mandatory vaccination of children among students of the Faculty of Health Studies and the Faculty of Medicine of the University of Mostar. Respondents and methods: A cross-sectional survey was conducted, which included 150 respondents in the third and fourth year of study, 50 respondents from the Faculty of Medicine, and 100 respondents from the Nursing and Sanitary Engineering study tracks at the Faculty of Health Studies. Data were collected through a self-assessment questionnaire. Results: Over 90% of respondents have a positive attitude towards vaccination and would vaccinate their children. The results show that respondents form their attitudes about vaccination based on academic activities. Students with a positive attitude about vaccination also showed greater knowledge about it. Nursing students have the weakest knowledge, followed by showing a greater aversion to vaccines than other respondents. More than a quarter of respondents are convinced of the connection between autism and vaccines, and this is also the case for autoimmune diseases. Conclusion: Although students of biomedical studies have positive attitudes about vaccination, the level of knowledge was more significant among students of the Faculty of Medicine compared to the study tracks of the Faculty of Health Studies

Detection of voluntary blood donor with previous hepatitis B infection – a case report

Introduction: Hepatitis B is liver inflammation caused by the hepatitis B virus, with more than 250 million documented cases worldwide in the chronic form of infection. Markers of hepatitis B infection can be measured in the blood during or after infection and may be present in the form of specific hepatitis B surface antigen (HBsAg) or antibodies to hepatitis B surface (HBs), core (HBc), or envelope (HBe) antigens. Case report: A 42-year-old female, who successfully donated blood for the first time, underwent mandatory serological and molecular testing along with additional testing for other hepatitis B markers. Standard screening showed the absence of HBsAg in the blood, but additional serological testing confirmed the presence of total antibody to hepatitis B core antigen (anti-HBc). Upon repeated reactive results, the sample was sent for confirmatory testing to a reference center. After obtaining all the results, it was determined that the voluntary blood donor had the presence of anti-HB cand HBs antibodies, indicating a prior contact with the hepatitis B virus. While serological tests suggested a resolved hepatitis B infection, the possibility of a persistent liver infection could not be ruled out, despite the absence of detectable hepatitis B virus DNA in the blood. Therefore, the individual has been permanently excluded from the list of potential blood donors. Conclusion: Mandatory serological and molecular testing of blood donors for the hepatitis B virus successfully detects potentially infected individuals and carriers of hepatitis B markers. However, additional testing further enhances the safety of both recipients and blood donors. This case study highlights the importance of comprehensive screening for hepatitis B markers, as relying solely on HBsAg screening would not have identified the voluntary blood donor as a resolved hepatitis B case. Thus, comprehensive screening ensures a higher level of safety in blood transfusion and contributes to overall healthcare protection

The 2019 measles epidemic in Bosnia and Herzegovina: What is wrong with the mandatory vaccination program?

Measles are a highly contagious and communicable viral disease which may be prevented by a sustained vaccination program. Due to missed vaccination, two major epidemics of measles (1997–1999 and 2014–2015) have been recorded after the war in Bosnia and Herzegovina (BH) with over 10,000 patients registered. According to the World Health Organization, BH is categorized as a country with endemic transmission of measles. The last measles epidemic was between 2014 and 2015, with 5,083 documented patients in the Federation of BH. In the first four months of 2019, more than 700 measles cases were registered in the same region. Significant transmission rate has been observed in Sarajevo Canton (SC) with 570 documented measles cases. Out of 570 measles cases in SC, 92.5% were unvaccinated. The most affected were children up to 6 years of age (62.8%), with one documented case of death (7-month old infant). In addition to this report, we discussed key stakeholders and possible circumstances responsible for the epidemic. The measles epidemic is still ongoing

Conservative treatment of lumbar brucellar spondylodiscitis with epidural abscess – a case report

Bruceloza je bolest koja se može manifestirati brojnim kliničkih simptoma i zahvaćenošću u gotovo svih organa. U zadnjih 15-ak godina bruceloza je poprimila karakteristike endemske bolesti u Bosni i Hercegovini. U ovom radu je prikazana pedesetosmogodišnjakinja koja je primljena u Kliniku za infektivne bolesti Sveučilišne kliničke bolnice Mostar zbog bolova koji su se širili iz područja lumbalne kralježnice u noge unatrag dva mjeseca te vrućice koja se pojavila dva dana prije prijama u bolnicu. Prikupljanjem epidemioloških podataka doznalo se kako je bolesnica u izravnom svakodnevnom kontaktu s ovcama, a dijagnostičko promišljanje u smjeru bruceloze je potvrđeno serološkom pretragom reakcije vezanja komplementa (RVK). Zbog neuroloških tegoba učinjena je magnetna rezonanca (MRI) lumbalne kralježnice i scintigrafija kostiju, koje su ukazivale na postojanost spondilodiscitisa s epiduralnim apscesom u području kralješka L5, a konzervativno liječenje je nastavljeno ukupno 18 mjeseci. Ovim prikazom smo htjeli ukazati na složenost dijagnostičkih pretraga i liječenja težih koštanih komplikacija bruceloze.Brucellosis is a disease which manifests through a wide range of clinical symptoms, possibly affecting any organ. In the last 15 years, brucellosis has been characterized as an endemic disease in Bosnia and Herzegovina. This case report presents a 58-year-old female who was admitted to the Department of Infectious Diseases of the University Hospital Mostar due to back pain spreading down through legs lasting for two months and fever that appeared two days prior to admission. Epidemiological history revealed that the patient had everyday direct contact with sheep. Diagnostic consideration of brucellosis was confirmed by complement fixation test (CFT). Due to verified neurological deficit, magnetic resonance imaging (MRI) and bone scintigraphy were performed, confirming spondylodiscitis with epidural abscess on spinal level L5, therefore conservative treatment was prolonged up to a total of 18 months. In this case report, we emphasized the complexity of diagnostic procedures and treatment of severe bone complications of brucellosis

Ishod bolesti u COVID-19 bolesnika liječenih remdesivirom u Općoj bolnici Zadar u razdoblju od 1. kolovoza 2020. do 1. kolovoza 2021. godine

Bolest uzrokovana SARS-CoV-2 (COVID-19) izrazito je zarazna bolest, koja zadnje tri godine ima izuzetno loš utjecaj na svjetsku demografiju, rezultirajući s gotovo 6,5 milijuna umrlih diljem svijeta. U ovom trenutku još uvijek ne postoji učinkoviti ciljani lijek, a liječenje određuje težina bolesti. Terapija remdesivirom pokazala je određeno kliničko poboljšanje, zbog čega ga je Food and Drug Administration odobrio kao prvi ispitivani lijek u liječenju COVID-19. Ovo retrospektvno opservacijsko istraživanje uključilo je bolesnike liječene remdesivirom u Općoj bolnici Zadar u razdoblju od 1. kolovoza 2020. do 1. kolovoza 2021. godine. Primarni cilj bio je utvrditi komorbiditete i klinički ishod bolesnika liječenih remdesivirom. Najčešće kronične bolesti bile su arterijska hipertenzija (80; 58,4%), dijabetes (44; 32,1%) i maligne bolesti (14; 10,2%). Ukupno je 86 bolesnika (62,7%) pripadalo skupinama teško i kritično bolesnih, a preostalih 51 (37,2%) bili su umjereno bolesni. Smrtnost je bila značajno veća u skupini teško bolesnih i iznosila je 23,4%, dok je u skupini umjereno bolesnih bila 5, 9% ( p=0,0287)

Excretion of SARS-CoV-2 RNA in feces has no prognostic benefit in the outcome of COVID-19: A clinical and immunological study

This study explores the correlation between immunological and clinical characteristics in coronavirus disease 2019 (COVID-19) patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in feces, analyzing data from 251 patients admitted to Mostar University Clinical Hospital (UCH) from December 2021 to January 2022. Methods involved reverse transcription quantitative polymerase chain reaction (RT-qPCR) from nasopharyngeal (NP) swabs and feces, alongside serological tests for anti-SARS-CoV-2 spike IgGs. Demographic and clinical data were collected through questionnaires and medical records. The data analyses were performed using SPSS statistical software. Death occurred in 53 patients (21.1%, P < 0.001), mostly in the elderly (47/53, 88.7%, P = 0.001) and immunocompromised (19/53, 35.8%, P = 0.05), particularly those developing acute respiratory insufficiency (ARI) (46/53, 86.8%, P = 0.004), and severe/critical disease (46/53, 86.8%, P = 0.002). Among the patients with positive anti-SARS-CoV-2 IgG antibodies (86/251, 34.3%, P < 0.001), 41 (47.7%) were vaccinated and 45 (52.3%) unvaccinated (P = 0.666), showing no significant differences in clinical outcomes or mortality. Unvaccinated patients with a negative antibody titer had a higher incidence of ARI (96/123, 78%, P = 0.029) and intensive care unit (ICU) admission (22/123, 17.9%, P = 0.026), than those with a positive antibody titer. Forty-seven (62.7%) patients, out of the 75 hospitalized who provided a feces sample, were positive for SARS-CoV-2 RNA (P = 0.028), without statistical differences between fecal SARS-CoV-2 positive and negative groups regarding vaccination status (15/47, 31.9%, P = 0.493), antibody status (18/47, 38.3%, P = 0.628), or death outcome (5/47, 10.6%, P = 0.706). In conclusion, unvaccinated hospitalized patients with a severe COVID-19 presentation and a negative anti-spike SARS-CoV-2 IgG titer had adverse outcomes more frequently. This suggests cautious consideration for the diagnostic use of fecal samples compared to NP swabs

Neurological Complications of COVID-19

Koronavirusna bolest u 2019. godini (COVID-19) uzrokovana je novootkrivenim korona virusom tipa 2 koji uzrokuje teški akutni respiratorni sindrom (SARS-CoV-2). Virus je otkriven u prosincu 2019. godine, a od strane Svjetske zdravstvene organizacije je, zbog broja oboljelih i proširenosti širom svijeta, proglašena pandemija. Klinička prezentacija COVID-19 varira od asimptomatskog do teškog oblika i smrtnog ishoda. Iako kliničkom slikom dominiraju respiratorne smetnje, mnogobrojne studije ukazuju na pojavu akutnih i kroničnih neuroloških komplikacija u skoro trećine oboljelih. Najčešći neurološki simptomi akutne faze COVID-19 su glavobolja, gubitak njuha i okusa, poremećaji stanja svijesti, encefalopatije, encefalitisi, moždani udar, bolovi u mišićima, epileptički napadaji, poliradikulopatije (GBS) te pojačan umor i netolerancija napora, poremećaji vegetativnih funkcija, kognitivne i psihičke smetnje u postinfekcijskoj fazi oboljenja. Potencijalni patofiziološki mehanizam nastanka neuroloških poremećaja u akutnoj fazi uključuje koagulopatije s udruženim hipoksično-ishemijskim oštećenjima, poremećajem krvno-moždane barijere, endoteliopatijama i neuroinvazijom virusa, udruženom s neuro-imunim odgovorom. Cilj ovog članka je prikazati najčešće akutne i kronične neurološke poremećaje vezane uz COVID-19 kod odraslih bolesnika kao i potencijalni patofiziološki mehanizam nastanka neuroloških poremećaja, a buduće epidemiološke studije o bolesnicima s COVID-19 bi trebali utvrditi pravu incidenciju neuroloških komplikacija COVID-19, razgraničiti specifične neurološke sindrome, postaviti dijagnostičke i terapijske protokole ta razjasniti mehanizam nastanka poremećaja.Coronavirus disease in 2019 (COVID-19) is caused by the newly discovered coronavirus type 2 which causes severe acute respiratory syndrome (SARS-CoV-2). The virus was discovered in December 2019, and the World Health Organization has declared a pandemic due to the number of cases and the spread around the world. The clinical presentation of COVID-19 varies from asymptomatic to severe and lethal outcome. Although the clinical picture is dominated by respiratory disorders, numerous studies indicate the occurrence of acute and chronic neurological complications in almost a third of patients. The most common neurological symptoms of the acute phase of COVID-19 are headache, loss of smell and taste, disturbances of consciousness, encephalopathies, encephalitis, stroke, muscle pain, epileptic seizures, polyradiculopathy (GBS) and increased fatigue and intolerance to stressful and mental disorders in the postinfectious phase of the disease. Potential pathophysiological mechanisms of the development of neurological disorders in the acute phase include coagulopathies with associated hypoxic-ischemic damage, blood-brain barrier disorder, endotheliopathies and neuroinvasion of viruses with associated neuro-immune response. The objective of this paper is to present the most common acute and chronic neurological disorders related to COVID-19 in adult patients as well as the potential pathophysiological mechanism of neurological disorders, and future epidemiological studies on patients with COVID-19 should determine the true incidence of specific neurological syndromes, to establish diagnostic and therapeutic protocols and to clarify the mechanism of disorder development

Short epidemiological overview of the current situation on COVID-19 pandemic in Southeast European (SEE) countries

We are living in times where a viral disease has brought normal life in much of the world to a halt. The novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) started in December 2019 in Wuhan, China initially and in a short time crossed the European borders. After mitigating the epidemic in China, Italy became one of the most COVID-19 affected countries worldwide. International travelers are important sources of infectious diseases and a possible source of epidemic. Due to its political, geographic, and cultural similarities, Italy is one of the main economic partners of Southeast European (SEE) countries. Our data show that infection in index cases in all 11 SEE countries was travel-related with Italy being a source country for 8/11 countries. After the first case identifications on February 25, the number of cases in SEE countries is continually rising reaching the total number of 15,612 with 565 fatal cases and overall case fatality ratio (CFR) of 3.6 (median 3.8, range 0.8–5.5) by April 10, 2020. At a time when the COVID-19 pandemic is approaching its peak, apart from the problems with treatment of the disease and care for critically ill patients, there are other equally important problems, such as organization of outbreak response, provision of health care, lack of hospital personnel, disruption of personal protective equipment supply chains and health care workers (HCWs) protection. But what is more important is the heroic behavior of the HCWs who are showing their humanity by disregarding their lives