Mpox virus DNA detection in different clinical specimens: tertiary-level laboratory experience, Bosnia and Herzegovina, 2022

Mpox virus (MPXV) infection is difficult to distinguish from other (non-)infectious diseases. The etiology of rash can be differentiated by real-time polymerase chain reaction (rtPCR) on different types of samples. The study aims to provide experience with emerging MPXV diagnostics in a tertiary-level laboratory in Bosnia and Herzegovina. From July-December 2022, a total of 18 mpox suspected persons were tested. MPXV infection was confirmed by rtPCR in 10/18 (55.56 %) persons. The number of cases reached a peak in October 2022. The lowest median Crossing point (Cp) (x̄ = 29.76) was obtained from a swab of skin lesions in a viral transport medium (VTM). Evaluating the Cp values for the 7/9 mpox cases from whom paired swab samples from different anatomic sites were collected, higher positivity of skin lesion swabs in VTM was observed. In conclusion, our data highlighted the confirmatory role of rtPCR in the diagnosis of MPXV in skin lesion samples.

Diversity of Trichinella species in carnivores from Bosnia and Herzegovina

BACKGROUND

In Bosnia and Herzegovina, domestic and wild carnivores represent a significant driver for the transmission and ecology of zoonotic pathogens, especially those of parasitic aetiology. Nevertheless, there is no systematic research of Trichinella species in animals that have been conducted in Bosnia and Herzegovina, even though trichinellosis is considered the most important parasitic zoonosis. The available results of the few studies carried out in Bosnia and Herzegovina are mainly related to the confirmation of parasitic larvae in the musculature of domestic pigs and wild boars or data related to trichinellosis in humans. The objective of our study was to present the findings of a comprehensive investigation into the species composition of Trichinella among 11 carnivorous species within the territory of Bosnia and Herzegovina, as follows: red fox (Vulpes vulpes), grey wolf (Canis lupus), brown bear (Ursus arctos), wildcat (Felis silvestris), pine marten (Martes martes), European badger (Meles meles), weasel (Mustela nivalis), European polecat (Mustela putorius), Eurasian lynx (Lynx lynx), but also dog (Canis lupus familiaris) and cat (Felis catus).

RESULTS

In the period 2013-2023, carnivore musculature samples (n = 629), each consisting of 10 g of muscle tissue, were taken post-mortem and individually examined using the artificial digestion method. In the positive samples (n = 128), molecular genotyping and identification of parasitic larvae of Trichinella spp. were performed using a PCR-based technique up to the species/genotype level. Positive samples were used for basic PCR detection of the genus Trichinella (rrnS rt-PCR technique) and genotyping (rrnl-EVS rt-PCR technique). The Trichinella infection was documented for the first time in Bosnia and Herzegovina among red foxes, grey wolves, brown bears, dogs, badgers and Eurasian lynx, with a frequency rate of 20.3%. Additionally, the presence of T. britovi infection was newly confirmed in Bosnia and Herzegovina, marking the initial documented cases. Furthermore, both T. britovi and T. pseudospiralis infections were observed in the wildcat population, whereas T. britovi and T. spiralis infections were detected in pine martens. Consistent with previous research, our findings align particularly regarding carnivores, with data from other countries such as Germany, Finland, Romania, Poland and Spain, where T. britovi exhibits a wider distribution (62.5-100%) compared to T. spiralis (0.0-37.5%). T. britovi is more common among sylvatic carnivores (89.0%), while T. spiralis prevails in wild boars (62.0%), domestic swine (82.0%) and rodents (75.0%).

CONCLUSION

The results of our study represent the first molecular identification of species of the genus Trichinella in Bosnia and Herzegovina. Additionally, our findings underscore the necessity for targeted epidemiological studies to thoroughly assess trichinellosis prevalence across diverse animal populations. Considering the relatively high frequency of trichinellosis infection in investigated animal species and its public health implications, there is an evident need for establishing an effective trichinellosis surveillance system in Bosnia and Herzegovina.

Application of machine learning models and landsat 8 data for estimating seasonal pm 2.5 concentrations

Air pollution is a significant global challenge that affects many cities. In Europe, Bosnia and Herzegovina (BiH) are among the most highly polluted and are mainly affected by air pollution. In this study, we integrate open-source landsat 8 remote sensing products, topographical data, and the limited ground truth PM2.5 data to spatially predict the air quality level across different seasons in Tuzla Canton, BiH by adopting three pre-existing machine learning models, namely XGBoost, K-Nearest Neighbour (KNN) and Naive Bayes (NB). These classification models were implemented based on landsat 8 bands, environmental-derived indices, and topographical variables generated for the study area. Based on the predicted results, the XGBoost model exhibited the highest overall accuracy across all seasons. The predicted model results were used to generate spatial air quality maps. Based on the classification maps, the PM2.5 air quality level predicted for Tuzla Canton in the Winter Season is very unhealthy. The findings conclude that the PM2.5 air quality concentration in Tuzla Canton is relatively unsatisfactory and requires urgent intervention by the government to prevent further deterioration of air quality in Tuzla and other affected cantons in BiH.

Comparison between conventional open-heart valve surgery and minimally invasive valve replacement surgery regarding the length of hospital stay and usage of blood derivates: insights from a single-centre, single-surgeon study conducted in Bosnia and Herzegovina

Aim To analyse the correlation between different surgical methodologies employed in valve diseases treatment and their subsequent impact on the duration of hospitalization. Methods This retrospective study conducted at the Clinical Centre of the University of Sarajevo analysed medical records of 163 valve disease patients treated between January 2019 and November 2022. The patients were divided into two groups: 77 had openheart valve surgery and 86 underwent minimally invasive cardiac surgery (MICS). Results The mean duration of the surgical procedures was 3.9±1.3 hours, with conventional open-heart surgery requiring an average of 3.6±1.1 hours and minimally invasive cardiac surgery (MICS) procedure 4.2±1.5 hours. No substantial disparities were found in the total length of hospitalization between the two groups, as both conventional (8.2±4.5 days) and MICS (8.7±7.0 days) demonstrated similar duration. Similarly, the total duration of intensive care unit (ICU) stay displayed similarity, with conventional surgery patients staying an average of 3.9±2.8 days and MICS patients of 4.2±4.1 days. The pattern of blood transfusion and fresh-frozen plasma usage revealed higher rates in the conventional valve surgery group comparing to the MICS group. Conclusion Minimally invasive valve surgery, despite slightly longer operative times, resulted in lower blood transfusion requirements and comparable hospitalization and ICU stay.

Ongoing measles outbreak, the Federation of Bosnia and Herzegovina, December 2023 to February 2024

We report on an ongoing measles outbreak in the Federation of Bosnia and Herzegovina with 141 cases notified between week 52 2023 and week 6 2024. Among those with known vaccination status, 97% were unvaccinated and the most affected group is children under the age of 5 years (n = 87) who were not vaccinated during the pandemic years. Sixty-eight cases were hospitalised, the most common complications were measles-related pneumonia and diarrhoea. The sequenced measles viruses from four cases belonged to genotype D8.

Metagenomic Sequencing of Lloviu Virus from Dead Schreiber's Bats in Bosnia and Herzegovina

Bats are a natural host for a number of viruses, many of which are zoonotic and thus present a threat to human health. RNA viruses of the family Filoviridae, many of which cause disease in humans, have been associated with specific bat hosts. Lloviu virus is a Filovirus which has been connected to mass mortality events in Miniopterus schreibersii colonies in Spain and Hungary, and some studies have indicated its immense zoonotic potential. A die-off has been recorded among Miniopterus schreibersii in eastern Bosnia and Herzegovina for the first time, prompting the investigation to determine the causative agent. Bat carcasses were collected and subjected to pathological examination, after which the lung samples with notable histopathological changes, lung samples with no changes and guano were analyzed using metagenomic sequencing and RT-PCR. A partial Lloviu virus genome was sequenced from lung samples with histopathological changes and found to be closely related to Hungarian and Italian virus sequences. Further accumulation of mutations on the GP gene, coding the glycoprotein responsible for cell tropism and host preference, enhances the need for further characterization and monitoring of this virus to prevent spillover events and protect human health.

Molecular characterization and phylogenetic analysis of highly pathogenic H5N1 clade 2.3.4.4b virus in Bosnia and Herzegovina

Influenza A virus continues to represent a growing problem affecting mainly birds but with an increasing number of mammal transmission events reported each year. Nevertheless, molecular characterization and phylogenetic analysis of influenza A viruses originating from all confirmed cases have not been systematically performed in all parts of the world. In this study, we investigated a sample originating from a mute swan that died in November 2021 in the northern part of Bosnia and Herzegovina with RT-qPCR and whole genome sequencing using ONT MinION. It was diagnosed as a highly pathogenic Influenza A virus, subtype H5N1 of 2.3.4.4b clade, and phylogenetic analysis revealed high sequence homology with other European HPAI H5N1 sequences at the time. The notable detected mutations in HA (N110S and T139P) and NA genes (H155Y), that facilitate the host specificity shift and enable the resistance to some antiviral drugs respectively, underscore the necessity of virus evolution surveillance. Therefore, the rapid dissemination of information, including virological and molecular data, is essential for the introduction of tailored prevention measures for infected animals, providing clearer insight and better awareness of a potential public health threat.

Correlation analysis of different optical remote sensing indices for drought monitoring: a case study of Canton Sarajevo, Bosnia and Herzegovina

Droughts are second to hurricanes the world's most costly weather events. Damage caused by droughts in certain countries is measured in tens of billions of dollars per year. Timely detection of drought and prediction of its occurrence has the potential to reduce costs and save a large number of people from its consequences. Numerous methods that serve this purpose exist in scientific research and practice. One group of drought monitoring methods belongs to the field of remote sensing, where it is possible to monitor drought indicators over large areas in almost real-time through satellite images. This paper is focused on the optical indices of remote sensing calculated by raster algebra. The intention was to reach conclusions about the quality of individual indices used for the Canton Sarajevo area in Bosnia and Herzegovina for each month of August in the period 2008-2021 through correlational and qualitative analysis and the use of meteorological indicators. Among the used indices, NDVI (normalized difference vegetation index) and NMI (normalized moisture index) proved to be the most reliable, and their mutual correlation was very strong (r = 0.99).

Evolution of seroprevalence to SARS-CoV-2 in blood donors in Sarajevo Canton, Federation of Bosnia and Herzegovina: Cross-sectional and longitudinal studies

Background

Sarajevo Canton in the Federation of Bosnia and Herzegovina has recorded several waves of high SARS-CoV-2 transmission and has struggled to reach adequate vaccination coverage. We describe the evolution of infection- and vaccine-induced SARS-CoV-2 antibody response and persistence.

Methods

We conducted repeated cross-sectional analyses of blood donors aged 18-65 years in Sarajevo Canton in November-December 2020 and 2021. We analyzed serum samples for anti-nucleocapsid (anti-N) and anti-spike (anti-S) antibodies. To assess immune durability, we conducted longitudinal analyses of seropositive participants at 6 and 12 months.

Results

One thousand fifteen participants were included in Phase 1 (November-December 2020) and 1152 in Phase 2 (November-December 2021). Seroprevalence increased significantly from 19.2% (95% CI: 17.2%-21.4%) in Phase 1 to 91.6% (95% CI: 89.8%-93.1%) in Phase 2. Anti-S IgG titers were significantly higher among vaccinated (58.5%) than unvaccinated infected participants across vaccine products (p < 0.001), though highest among those who received an mRNA vaccine. At 6 months, 78/82 (95.1%) participants maintained anti-spike seropositivity; at 12 months, 58/58 (100.0%) participants were seropositive, and 33 (56.9%) had completed the primary vaccine series within 6 months. Among 11 unvaccinated participants who were not re-infected at 12 months, anti-S IgG declined from median 770.1 (IQR 615.0-1321.7) to 290.8 (IQR 175.7-400.3). Anti-N IgG antibodies waned earlier, from 35.4% seropositive at 6 months to 24.1% at 12 months.

Conclusions

SARS-CoV-2 seroprevalence increased significantly over 12 months from end of 2020 to end of 2021. Although individuals with previous infection may have residual protection, COVID-19 vaccination is vital to strengthening population immunity.

The role of National Immunization Technical Advisory Groups in advising COVID-19 immunization policy during the pandemic: lessons from the Federation of Bosnia and Herzegovina

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of experts that provides evidence-based recommendations on immunizations to policy-makers to assist them in making immunization policy and program decisions. NITAGs faced challenges in making evidence-based recommendations for COVID-19 vaccines during the COVID-19 pandemic due to the new vaccine products available in a short time period and limited available data on vaccine effectiveness and vaccine safety. The authors reviewed the process used by the NITAG in the Federation of Bosnia and Herzegovina, called the expert body, to develop COVID-19 vaccine recommendations. The article reviews the evidence that was considered by the expert body when developing 23 recommendations on COVID-19 vaccination and describes the challenges and successes faced by the body. The expert body recommendations led to the successful roll-out of COVID-19 vaccines and provided guidance for COVID-19 vaccination during the pandemic. The expert body plans to improve its work and procedures for developing routine immunization recommendations with the support of the WHO Regional Office for Europe.

The Attitudes and Practices Regarding COVID-19 among General Practitioners from Croatia and Bosnia and Herzegovina: A Cross-Sectional Study

Attitudes toward COVID-19 (coronavirus disease 2019) prevention and control may have influenced general practitioners' (GPs') work during the COVID-19 pandemic. The present study aimed to investigate the attitudes and practices of GPs from Croatia and Bosna and Herzegovina regarding COVID-19 prevention and control as well as the factors which may have influenced them. A cross-sectional study using a self-administered, anonymous questionnaire was conducted between February and May of 2022 on 200 Croatian and Bosnian GPs. The study revealed that the attitudes and practices of the surveyed GPs regarding COVID-19 prevention and control were satisfactory. The Croatian GPs reported a larger number of positive attitudes toward COVID-19 prevention and control (p = 0.014), while no significant differences in practices were established. Among the Croatian GPs, more positive attitudes toward COVID-19 prevention and control were reported by participants who had finished a formal education on the prevention of infectious diseases and occupational safety (p = 0.018), while among the Bosnian GPs, more positive attitudes were reported by older GPs (p = 0.007), males (p = 0.026), GPs with a longer length of service (p = 0.005), GPs who had finished a formal education on the prevention of infectious diseases and occupational safety (p < 0.001), GPs who had finished a formal education on adequate hand hygiene (p < 0.001), and GPs who had finished a formal education on COVID-19 prevention for GPs (p = 0.001). Considering GPs' practices regarding COVID-19 prevention and control, among the Croatian GPs, more positive practices were reported by older GPs (p = 0.008), females (p = 0.002), GPs who had a partner (p = 0.021), GPs who were specialists in family medicine (p = 0.014), GPs with a longer length of service (p = 0.007), and GPs who had finished a formal education on the prevention of infectious diseases and occupational safety (p = 0.046), while among the Bosnian GPs, no significant correlations were determined. The general practitioners' sociodemographic and employment characteristics strongly influenced their attitudes and practices regarding the prevention and control of COVID-19. The cultural differences between Croatia and Bosnia and Herzegovina, as well as the organizational specificities of their healthcare systems, probably modified the observed differences in the individual patterns of associations between the outcome and explanatory variables in the surveyed neighboring countries.

Family Physicians' Perceptions of Primary Health Care Use in Bosnia and Herzegovina during the Covid-19 Pandemic, a Cross-sectional Study

OBJECTIVES

The main objective of this paper was to examine the perceptions of family physicians on the use of primary health care in Bosnia and Herzegovina during the COVID-19 pandemic.

MATERIALS AND METHODS

A cross-sectional study was conducted using a short online questionnaire that was sent to primary care physicians in Bosnia and Herzegovina from April 20th, 2022, to May 20th, 2022.

RESULTS

The research sample consisted of 231 doctors of primary health care from Bosnia and Herzegovina, with an average age of 45 years and 85% women. About 70% of participants reported having COVID-19 at least once from March 2020 to March 2022. Participants had an average of 1,986 registered patients and approximately 50 encounters per day. The study revealed a high degree of reliability between test-retest measurements, with a single measure Intraclass correlation coefficient of 0.801, and internal consistency determined using Cronbach's alpha of 0.89. Participants reported that the following health services were most affected during the COVID-19 pandemic: care for patients with chronic diseases, home visits, navigating the health system with patients making appointments with specialists, cancer screening, and preventive health services. The study also found statistically significant perceived differences in the use of these health services based on age, gender, postgraduate education in family medicine, participation in COVID-19 clinics, and personal history of Covid-19.

CONCLUSION

There were significant disturbances to the use of primary health care during the COVID-19 pandemic. Future research could investigate patient outcomes compared to family physician perceptions.

Ethnobotanical study of traditionally used plants in the municipality of Zavidovići, BiH

ETHNOPHARMACOLOGICAL RELEVANCE

Bosnia and Herzegovina (BiH) is a country with a highly diverse ecosystem, containing over 5000 confirmed taxa of vascular plants. The traditional medicinal use of plants has always played a crucial role and gained in importance in the time of war in the 1990s due to a lack of medical facilities. Still nowadays, the health care system is poorly developed, which altogether makes the region interesting for ethnopharmacological researches.

AIM OF THE STUDY

Focusing on the area of Zavidovići Municipality in the central part of the country, we aimed to document the diversity of the used medicinal plants and the knowledge of their therapeutic usages.

MATERIAL AND METHODS

Data was collected in individual open and semi-structured interviews. Therapeutic uses were classified into 14 disease categories following the International Classification of Primary Care-2 (ICPC-2), a classification system recognized by the World Health Organization's Family of International Classifications (WHO-FIC). Use reports have been used to evaluate the acquired knowledge.

RESULTS

The findings revealed a total of 113 species belonging to 46 families. 14 informants well respected for their knowledge in the area listed 77 therapeutic uses for the indicated plants. Based on a comparison with other ethnobotanical surveys of BiH and to other important relating literature, three taxa have not been previously reported in BiH and for 19 species, new medicinal uses were stated. Based on use reports, oral application of remedies is far more common (76,7%) than external application (23,3%), the dominant mode of preparation thereby is an infusion. Usages of most concern were digestive, urological and respiratory diseases, their consensus factor ranging between 0,63 and 0,71.

CONCLUSION

These results summarize the usage of traditional plants among people who are highly valued in their community of Zavidovići Municipality for their knowledge and thereby aim to preserve the indigenous knowledge associated with the medicinal plants of the area.

Epidemiology and risk factors of trichinellosis in Bosnia and Herzegovina from 1961 to 2021

This study is a retrospective analysis of social, economic, political, and cultural events on the annual incidence of trichinellosis in Bosnia and Herzegovina (BiH). It highlights the importance of specific regulations, which have been incorporated into developing preventive protection against this human disease for the last 61 years since it has been monitored by law. In the period, 1961-2021, 3828 people became infected. The first outbreak of trichinellosis was documented in 1965, and the incidence peaked during the war and post-war period at the end of the twentieth century. At that time, outbreaks with hundreds of cases and five deaths were recorded. In the first decade of the twenty-first century, the incidence decreased, and at the end of the second decade, two consecutive years without trichinellosis cases were finally registered. The analysis shows that a significantly higher incidence rate was recorded between the two political entities of BiH, the Republic of Srpska (4.97% 000) versus the Federation of BiH (0.9% 000) and that the occurrence of trichinellosis in humans in BiH is related to the presence of Trichinella spp. in animals, of a degree of biosecurity on pig farms, population's awareness of safe food, the impact of tradition and religion on eating habits, doctors' awareness of the symptomatology, and the Trichinella spp. larva detection method in muscle samples. The spread risk of trichinellosis requires meat inspection for Trichinella spp. larvae to be mandatory in BiH.

Food waste perceptions and reported behaviours during the first wave of the COVID-19 pandemic: Evidence from Bosnia and Herzegovina

An increasing corpus of data demonstrated the disruptive impacts of the COVID-19 pandemic on food consumption habits, particularly food waste, but the Balkan area is often overlooked. Accordingly, this study investigates the immediate effects of the COVID-19 pandemic on consumer knowledge and reported behaviours linked to food waste in Bosnia and Herzegovina. The research was based on an online survey with 2425 participants using the Google forms platform from 10 April to 10 May 2020. This period coincided with the first wave of the COVID-19 pandemic in Bosnia and Herzegovina. Consumers' behaviours regarding where and how often they buy food, their attitude towards food labels, food provision and particularly the amounts and values of food waste and how they handle it were investigated. The data were analysed using descriptive statistics methods, and the significance of the association between variables was determined using nonparametric and multivariate statistical tests. The study's findings revealed that (i) Bosnia has a low rate of household food waste and a favourable attitude towards food waste prevention, (ii) the majority of the respondents are familiar with the most common expiry labels, notably 'use by' and 'best before' and (iii) consumers adjusted their buying and consumption patterns due to the pandemic. The findings of this research are essential for developing evidence-based policy in Bosnia and Herzegovina during the post-pandemic recovery period since they are unique to that country. Indeed, the crisis' lessons and insights may be used to help move towards more sustainable consumption habits.

Fiscal policies in the Federation of Bosnia and Herzegovina: are spending or revenue measures more effective?

We examine the effectiveness of different fiscal policies in the Federation of Bosnia and Herzegovina (FBiH). For this purpose, we use a structural macroeconomic model for the FBiH. In this model, GDP in the Federation is influenced by world demand and by domestic demand in the Federation. Domestic demand comprises consumption of private households, public consumption, and gross fixed capital formation. Employment depends positively on GDP and negatively on the tax wedge, i.e., the net wage plus social security contribution rates (including the unemployment insurance), and the personal income tax rate in the Federation. The latter allows the analysis of the impact of changes in social security contribution rates or in the income tax rate in the Federation of Bosnia and Herzegovina. The following Federation-specific policy instruments are implemented in the model for the FBiH: Pension funds contribution rate in FBiH; contribution rate for health insurance in FBiH; contribution rate for the unemployment insurance in FBiH; benefits from social security; direct tax rates (income tax rate, corporate tax rate); public consumption in FBiH. Our results show that policy measures that reduce the tax wedge on labour income are highly effective in stimulating employment. Due to the large elasticity of imports with respect to demand, pure demand-side measures have little impact on real variables, indicating that a small open economy like the Federation of Bosnia and Herzegovina has only little scope for influencing macroeconomic developments with pure demand management policies. Our results confirm earlier theoretical and empirical studies showing that the labour market can best be influenced positively by reducing the tax wedge. The multipliers of income tax reductions are larger and oscillate more than the effects of the other fiscal policy measures.

Psychiatric Morbidity Among Older Hospitalized Patients

Background

Globally, life expectancy is increasing, leading to an equal proportion of elderly and young individuals, which carries extensive implications. In Bosnia and Herzegovina (BiH), the average age at death in 2021 was 77 years, positioning BiH in the middle of the global list of average life expectancy. Current studiesinvestigate whether the prevalence of psychiatric disorders increases or decreases with age, but results are inconsistent regarding the role of age.There is no prior research on mental disorders in the elderly population in BiH. The experience of the previous war in BiH and the post-war complex "transitional period" have been associated with specific challenges to the mental health of this population, inspiring our research topic.

Objective

The aim of this study was to investigate the psychiatric morbidity in hospitalized individuals aged≥55 years.

Methods

The sample consisted of all patients over age 55 treated at the Department of Psychiatry in Tuzla between January 2018 and December 2020 (N=637), divided into four age categories. Data were obtained from medical records, and for research purposes, a specific questionnaire was constructed.

Results

The predominant psychiatric morbidity stemmed from the category of affective disorders, most common within the "55-64 years" age group, while organic mental disorders were more prevalent in other age groups.Substance use disorders were present in patients aged "55-64 years", with a sharp decline in their prevalence in older age. Female participants had a significantly higher prevalence of affective, psychotic, neurotic, and stress-related disorders, whereas male participants exhibited an increased prevalence of organic mental and substance use disorders.

Conclusion

In total sample, the most prevalent diagnoses belong to the category of affective disorders. Female were most frequently diagnosed with affective disorders, whereas organic mental disorders and substance use disorders prevail in male.

Genetic diversity of Echinococcus granulosus sensu lato from animals and humans in Bosnia and Herzegovina

BACKGROUND

Cystic echinococcosis (CE) is recognized as one of the most prevalent zoonotic diseases in Bosnia and Herzegovina. However, no systemic investigation of the genetic diversity of Echinococcus granulosus sensu lato circulating among animals and humans in the country has been performed to date.

METHODS

In this preliminary study, we analysed one cyst each from 36 sheep, 27 cattle, 27 pigs, 11 wild boars and 16 human patients for amplification and partial sequencing of the adenosine triphosphate 6 (atp6) and cytochrome c oxidase 1 (cox1) genes. The host species, fertility rate and organ cyst location were recorded for each subject involved in the study.

RESULTS

Overall, the atp6 gene was successfully amplified and sequenced from 110 samples, while 96 of the PCRs for cox1 were positive. Three zoonotic genotypes of E. granulosus sensu stricto (G1 and G3) and Echinococcus canadensis (G7) were identified in our isolates based on analyses of the atp6 gene. These genotypes were represented by 11 different genetic variants (haplotypes), six of which were identified for the first time in the present study.

CONCLUSIONS

This study demonstrates, for the first time, that CE in Bosnia and Herzegovina is predominantly caused by E. granulosus sensu stricto and E. canadensis clusters, which exhibited a lower genetic diversity compared to isolates from other European countries. Further molecular studies employing other mitochondrial and nuclear genes are required to better understand the transmission cycles of E. granulosus sensu stricto among intermediate and definitive hosts in the country.

"Today one partner, tomorrow another one, and no one is suspicious that you are gay": A Qualitative Study of Understanding HIV Related Risk Behavior Among MSM in Bosnia and Herzegovina

Men who have Sex with Men (MSM) are often exposed to stigma and discrimination, especially in developing countries. Discrimination might have an impact on their sexual behavior. The proportion of MSM among HIV positive persons is rising in Bosnia and Herzegovina (B&H). The aim of this qualitative study was to understand the country context and HIV-related risk behaviors among MSM in B&H. We found that MSM in B&H have a dominant fear of expressing their sexual orientation in the homophobic societal environment, including their own family. Disclosures are often connected with escalated family violence, followed by the silence and ignorance. The fear of being connected to one particular partner and being labeled as a gay lead to the need of "masking" their sexual orientation, and having sexual intercourse with non-steady sexual partners. Although most MSM were aware of the risk of HIV and other STIs, the fear of rejection and remaining alone, shapes their decisions to agree to have sex without condoms.

Epidemiological Aspects of Age and Genotypical Occurrence of HPV Infection Among Females of Canton Sarajevo Over a 10-year Period

Background

Human papillomaviruses (HPV) are one of the most prevalent causes of cervical, anal, and oral cancer, and it is believed that nearly all sexually active males and females have been infected with HPV at some point in their lives.

Objective

The purpose of this study is to highlight epidemiological characteristics of the age and genotypical incidence of HPV infection among females in Canton Sarajevo during a 10-year period.

Methods

This cross-sectional study was conducted in the period between January 2012 and December 2021 at the medical institutions "Zavod za Ginekologiju, Perinatologiju i Neplodnost "Mehmedbašić" among females who were admitted for a routine gynaecological exam in Canton Sarajevo in Bosnia and Herzegovina.

Results

In total, 1517 patients who reported typical sexarche at 18.35±1.92, having one 721 (47.5%) sexual partner, regular use of contraceptive methods 820 (54.5%) with male condom 513 (62.6%) being the dominant choice of contraception and having gynacological hereditary oncological positive history 141 (9.3%), were included in the study from which 653 (43.05%) patients had positive HPV test and 864 (56.95%) had negative HPV results. HPV positive patients, 386 (59.1%) were infected either with one type of virus only, while 267 (40.9%) patients were infected with multiple virus strains where we have identified 166 virus strain combinations. Analysis showed that the patients infected by only one virus strain were one of next specific HPV viruses: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68. HPV-16 was the predominately strain 16 (22.5%) identified among all the patients. Mean age of HPV positive patients was 33.38±7.85, ranging from 18 to 61 years.

Conclusion

This study highlights the significance of the most frequent HPV high-risk strains (HPV-16, -18, -31.-33,-45,-52, and -58) among the Bosnia and Herzegovina population as one of the most common cancer-causing strains worldwide.

Maša Živanović: A Pioneer in Health Care for Women and Children in Bosnia and Herzegovina

The aim of the article is to present, primarily to the medical world and also the general public, the personality and work of Maša Živanović (1890-1960), a pioneer in the health care of children and mothers in Bosnia and Herzegovina (BH), a health educator and one of the leaders of the Yugoslav Women's Rights Movement in the period between the two world wars. She was born in Croatia (then part of the Austro-Hungarian Empire) as Maria Skopszyński, in a family of Polish-Czech origin. After studying at the Temporary Women's Lyceum in Zagreb and passing the matriculation exam at the boy's High School (1909), she obtained the title of Doctor of Medicine in Vienna (1916). Her activity in the Women's Rights Movement has so far generally attracted more attention from researchers than her medical work. However, this work was very important because the general and health education of women, expectant mothers and mothers, after the two World Wars was very poor in BH, and the rates of child morbidity and mortality were high. Maša Živanović spent almost her entire working life in Sarajevo. For 30 years, she was the head of the Dispensary for Mothers and the Children, later the Institute for Maternal and Child Health Care, into which the previous institution grew in 1931. She was among the first followers of the new concept of "comprehensive paediatrics", which included social care for children, disease prevention and treatment of the sick. She successfully connected the medical mission with the mission of a women's rights activist, also trying to act as a health educator through articles published in the Women's Movement magazine (Ženski pokret). For a time, she was the president of the Society for the Education of Woman and Protection of her Rights, i.e. the Women's Movement, and a delegate at conferences of international feminist organizations. CONCLUSION: Maša Živanović was a physician, a pioneer in the health care of children and mothers in BH, a long-time director of the Institute for Health Care of Mothers and Children in Sarajevo, and one of the leaders of the Yugoslav Women's Rights Movement.

Comparison of Lanolin and Human Milk Treatment of Painful and Damaged Nipples: A Randomized Control Trial

BACKGROUND

Painful and damaged nipples are frequently associated with breastfeeding cessation in the early postpartum period. The results of researchers' studies utilizing different treatments have been inconclusive.

RESEARCH AIM

To compare the intensity of nipple pain and the healing of damaged nipples during the first 10 days postpartum using either lanolin or human milk treatments.

METHODS

This single-blind randomized controlled trial included participants (N = 206) who were primiparous with painful and damaged nipples. Participants were recruited from the tertiary teaching hospital within the first 72 hr after delivery and randomized to the intervention group with lanolin (n = 103) and a human milk control group (n = 103). Data were collected in the maternity ward, 3 and 7 days after randomization. The primary outcome was nipple pain intensity and quality measured 3 and 7 days after randomization by the McGill Pain Questionnaire - short form. The nipple damage self-assessment questionnaire was used for the assessment of nipple healing. Breastfeeding self-efficacy, breastfeeding duration, and exclusivity were assessed as secondary outcomes.

RESULTS

Participants in both groups reported a statistically nonsignificant reduction in pain (quality and intensity of pain) as well as improved nipple healing 7 days after randomization. Participants in the lanolin group exclusively breastfed their infants 3 days after randomization-significantly more often than participants in the control group (p = .026). The study did not reveal any statistically significant differences for other secondary outcomes.

CONCLUSION

Both lanolin and human milk are equally effective in treating painful and damaged nipples.Registered with Clinicaltrials.gov (NCT04153513).

COVID-19 Impact on Public Dental Healthcare in Bosnia and Herzegovina: Current Situation and Ongoing Perspectives

BACKGROUND

As the pandemic time went by in Bosnia and Herzegovina (B&H), various patterns toward COVID-19 itself and its impacts, implementation of prescribed preventive measures among the team members, and those of their patients, including immunization process, have been revealed. These patterns were of both empirical and evidence-based kind and consequently formed dental personnel behavior. The aim was to evaluate and compare the COVID-19 status of dentists in B&H, implementation of prescribed preventive measures, and usage of various kinds of PPE, at the beginning of the pandemics and now, 2.5 years later, including dentists' current vaccination status, and their opinions and attitudes toward the national COVID-19 economic impact on dental practice.

METHODOLOGY

Study research was in a form of a cross-sectional longitudinally designed online survey and was conducted in two parts.

RESULTS AND CONCLUSIONS

Dental professionals in B&H had a high frequency of COVID-19 symptoms in the second pandemic year. The vaccination status of dentists in B&H was in line with the global average values of vaccinated professionals. Dentists used patient management preventive measures and PPE recommended by WHO, but some preventive measures have been changed and prioritized recently. The economic impact of pandemics on dentistry was predominantly negative.

COVID-19 vaccination knowledge, attitudes and practices among residents of Bosnia and Herzegovina during the third wave of COVID-19 outbreak

Background

Bosnia and Herzegovina hasn't still developed and started any vaccination programs to contain the current COVID-19 outbreak and prevent further spreading and death from this disease. The aim of this study was to assess current knowledge, attitudes and practices towards COVID-19 vaccination during the third wave of the outbreak when the healthcare system is facing a collapse and to create a paradigm for developing vaccination programs in the country.

Methods

his cross-sectional study was conducted by an anonymous online questionnaire based on a Congo study and Center for Disease Control and Prevention facts regarding COVID-19 vaccination during the third wave of the COVID-19 outbreak in the country.

Results

In total, 570 subjects, mostly female 474 (83.1%), with a high school degree or lower 230 (40.3%), married 305 (53.5%), engaged in intellectual labor 302 (53.0%), from urban environment 531 (93.1%) and with a mean age of 35.28±11.35, were included in the study. The mean COVID-19 vaccination knowledge test score was 11.29±1.91. Being single (OR= 1.88, 95% 1.20-2.94) or in a relationship (OR=1.87, 95% 1.12-3.11), being engaged in intellectual labor (OR=1.59, 95% CI 1.06-2.37) and having a Master's degree or higher (OR=1.65, 95% CI 1.10-2.46) were associated with higher knowledge test scores. Only 264 (46.3%) subjects agreed that COVID-19 vaccination programs will prevail in a battle versus COVID-19 and only 36 (6.3%) were currently vaccinated against COVID-19. Higher knowledge regarding COVID-19 and its vaccination was determined as an independent predictor for vaccinating itself against COVID-19 (OR=23.09, 95% CI 11.94-44.68), as well as respecting socio-epidemiological measures such as avoidance of crowded places (OR=2.07, 95% CI 1.28-3.35) and wearing face mask (OR=6.95, 95% CI 2.07-23.29).

Conclusions

Our study shows that Bosnia and Herzegovina population has poor knowledge, relatively pessimistic attitudes and a very low vaccinal rate against COVID-19 during the third wave of the outbreak which promotes COVID-19 vaccination hesitancy and further COVID-19 spreading and death toll. By activating proper socioepidemiological measures and educating population about COVID-19 and COVID-19 vaccination, as well as vaccination against COVID-19, the current situation could be changed.

Medical Biography of Isak Samokovlija: The Famous Bosnian-Herzegovinian Writer

The purpose of this paper is to shed light on the biographical, professional, and health-educational works of Dr. Isak Samakovlija, who was better known as a writer than a doctor in the country where he was born. He was born in 1889 in Goražde, the easternmost province in the Austrian-Hungarian monarchy, into a modest Jewish merchant family. He attended high school in Sarajevo and completed his studies in medicine in Vienna in 1917. During the First World War, he served twice in the Austro- Hungarian army. After the end of the First World War in 1918, he completed a medical internship at the National Hospital in Sarajevo. He began his service as a doctor, first in Goražde and then in Fojnica and Sarajevo. After the establishment of the Independent State of Croatia in May 1941, he was dismissed from his duties in the service without the right to pension or support, and without the right to appeal. In the Independent State of Croatia, he was twice mobilized into the Home Guard and was manager of the clinic in the Alipašin Most refugee camp. After World War II, he was the head of the Health Education Department of the Ministry of Public Health of the People's Republic of Bosnia and Herzegovina in Sarajevo. Together with a group of enthusiastic doctors, he founded and edited the first Bosnian medical journal Život i Zdravlje (Life and Health). In that journal, Dr. Samokovlija published 29 articles of health and educational content. In 1949, Dr. Samokovlija left the Ministry of Public Health and continued to edit the literature and art journal Brazda, but he still had a private practice until the end of his life. He died in Sarajevo on January 15, 1955. He was buried with the highest state honors at the Jewish cemetery in Sarajevo. CONCLUSION: Isak Samakovlija (1889-1955) was one of the first medical doctors born in Bosnia and Herzegovina. He made a significant contribution to the improvement of people's health after the First and Second World Wars in the places where he worked. His special contribution are his articles on health education.

Serologic and molecular evidence for circulation of Crimean-Congo hemorrhagic fever virus in ticks and cattle in Bosnia and Herzegovina

Crimean-Congo haemorrhagic fever virus is a tick-borne zoonotic agent of the genus Orthonairovirus, and the causal agent of Crimean-Congo haemorrhagic fever in humans. The study is aimed at investigating the presence of CCHFV RNA in ticks and cattle in Bosnia and Herzegovina (B&H), as well as the exposure of cattle to CCHFV in this country. Only one pool of three male Hyalomma marginatum ticks tested positive for viral RNA (3/760, 0.39%). No viral RNA was detected in 206 bovine blood samples using real-time reverse-transcriptase PCR (RT-qPCR). The overall seroprevalence of CCHFV in the cattle population was estimated as 14.97% (72/481). The results indicate the presence and the established circulation of CCHFV in B&H. Considering the endemic character of CCHFV in the Balkans as well as our results, the possibility that CCHFV is endemic in the territory of Bosnia and Herzegovina is considered to be very high.

Redescription of Diastolaimus grossus (Truskova & Eroshenko, 1977) Andrássy, 1984 (Rhabditida, Chambersiellidae) from Europe and comments on its phylogenetic position

Two populations of the species Diastolaimus grossus have been obtained from bark of trees in Bosnia and Herzegovina and the Czech Republic. The species is described and characterized in detail using morphological techniques (light and electron scanning microscopy) and morphometrical (Gower General Similarity coefficient of morphological characters) and molecular analyses, including phylogenetic analysis of all related and already sequenced species of the family Chambersiellidae. Morphological and molecular analyses, based on 18S and 28S ribosomal DNA sequences, show that the family Chambersiellidae is polyphyletic, being the subfamily Chambersiellinae related with Cephalobomorpha and Tylenchomorpha, and the subfamily Macrolaiminae is located into Panagrolaimomorpha. The genus Diastolaimus, previously belonging to Macrolaiminae, is transferred to Chambersiellinae. Diastolaimus mexicanus is proposed as a junior synonym of D. grossus.

First evidence of Crimean-Congo haemorrhagic fever virus circulation in Bosnia and Herzegovina

BACKGROUND

Crimean-Congo haemorrhagic fever (CCHF) is a widespread tick-borne zoonosis with reported detection of virus and/or virus-specific antibodies from over 57 countries across Africa, Asia, Europe and the Middle East and is endemic in the Balkans. Detection of Crimean-Congo Haemorrhagic Fever Virus (CCHFV) antibodies in domestic ruminants has been important in providing initial evidence of virus circulation and in localising CCHFV high-risk spots for human infection.

OBJECTIVES

The present study investigated the possible exposure of sheep to CCHFV in Bosnia and Herzegovina (B&H).

METHODS

To investigate the presence of anti-CCHFV antibodies in sheep, all sera (n = 176) were tested using multi-species double antigen enzyme-linked immunosorbent assay (ELISA). Reactive sera were further complementary tested by adapted commercial indirect immunofluorescence assay (IFA) using FITC-conjugated protein G instead of anti-human immunoglobulins.

RESULTS

CCHFV specific antibodies were detected in 17 (9.66%) animals using ELISA test. All negative sera were determined as negative by both tests, while 13 out of 17 ELISA-positive reactors were also determined as unambiguously positive by IFA test. The age group with the highest proportion of seropositive rectors were the oldest animals.

CONCLUSIONS

This is the first report of anti-CCHFV antibodies in sheep from B&H providing the evidence of CCHFV circulation in the country's sheep population. So far, these findings indicate the circulation of the virus in the westernmost region of the Balkans and point to the potential CCHFV spread further out of this endemic area.

Prevalence of hepatitis B surface antigen (HBsAg) in blood donor population in Bosnia and Herzegovina: impact of the pre-donation questionnaire implementation and mandatory hepatitis B virus (HBV) vaccination schedule - 20 years' experience of the University Clinical Hospital Mostar

OBJECTIVES

Currently, there are limited data on the prevalence of HBsAg in Bosnia and Herzegovina. This study aimed to evaluate the trend of HBsAg prevalence during a period of 20 years in relation to the implementation of pre-donation questionnaires based on parenteral and sexual risk factors and mandatory HBV vaccination.

MATERIAL AND METHODS

This is a retrospective analysis performed on 67,336 blood donors at the University Clinical Hospital Mostar during three distinct periods: before introducing of mandatory HBV vaccination and pre-donation blood donor questionnaires (1998-2002); after introducing of pre-donation blood donor questionnaires, but without mandatory immunized blood donors (2004-2008); and after introducing of mandatory pre-donation blood donor questionnaires and mandatory vaccination (2015-2019).

RESULTS

According to implementation of mandatory pre-donation blood donor questionnaires and mandatory HBV vaccination the prevalence of HBsAg significantly decreased among blood donors in all three studied period of time (0.303% in 1998-2002, 0.236% in 2004-2008, and 0.021% in 2015-2019; P < 0.001). Out of 67,336 tested donors, there were 98 (0.145 %) HBsAg-positive donors during analysed periods, with a mean age of 34.76±11.37 years. The mean age of HBsAg-positive donors was 30.72±10.40, 37.56±10.13, and 47.28±12.14) in the 1998-2002, 2004-2008, and 2015-2019 periods, respectively (P < 0.001).

CONCLUSION

This study clearly shows a decreased rate of HBV infections among blood donors with respect to implementation of the HBV vaccination schedule and mandatory pre-donation blood donor questionnaires based on parenteral and sexual risk factors.

The impact of upbringing and the local community on the development of environmental awareness among college educated people in Bosnia and Herzegovina

Environmental problems are global problems today but the development of environmental awareness and the approach to one varies between the countries, and even between the municipalities of the same country. Numerous natural and social factors have an impact on its development. Research presented in this article collected the data from the inhabitants and analyzed the level of influence of the following social factors-education, upbringing and local community, on the development of environmental awareness among college educated people in Bosnia and Herzegovina. Data collected through the anonymous survey included answers of the population born after 1995, after the civil war in the country. Chosen questions are related to the waste disposal and processing along with the waste treatment in their communities and households. This article explores how strong the impact of these factors on the development of environmental awareness is and which of them has the greatest influence.

Antimicrobial resistance profiles of human Brucella melitensis isolates in three different microdilution broths: First multicentre study in Bosnia and Herzegovina

BACKGROUND

Brucellosis is a ubiquitous emergent bacterial zoonotic disease causing significant human morbidity in Bosnia and Herzegovina. So far, a high rate of resistant Brucella has been found worldwide. This study prospectively analysed the rates of resistance among human Brucella melitensis (B. melitensis) strains isolated in Bosnia and Herzegovina.

METHODS

This study included 108 B. melitensis isolates from 209 patients diagnosed at five medical centres in Bosnia and Herzegovina. The resistance profiles of the B. melitensis isolates for the 13 most commonly used antimicrobials were studied in standard Brucella broth (BB) and cation-adjusted Mueller-Hinton broth (CAMHB) supplemented with 4% lysed horse blood or 5% defibrinated sheep blood.

RESULTS

Of the 209 patients, B. melitensis blood cultures were positive for 111 (53.1%). Among the 108 isolates investigated, 91 (84.3%) were resistant to trimethoprim-sulfamethoxazole on BB, but not on either CAMHB. Nearly all isolates (>90%) were resistant to azithromycin on BB and both CAMHBs.

CONCLUSIONS

We observed a high rate of B. melitensis resistance to azithromycin. The high rate of resistance to trimethoprim-sulfamethoxazole that we observed was related to BB, so an alternative broth should be used, such as the enriched CAMHBs in this study, for evaluating resistance to trimethoprim-sulfamethoxazole. Whole-genome sequencing studies are needed to understand the development of antimicrobial resistance in B. melitensis strains isolated from humans.

A Unique Case of Fatal Coinfection Caused by Leptospira spp. and Hepatozoon canis in a Red Fox Cub (Vulpes vulpes)

Red foxes are the most abundant wild carnivore species in Europe commonly exposed to pathogenic Leptospira and Hepatozoon canis. Despite high seroprevalence, the clinical disease caused by these pathogens in red foxes has never been reported. Herein, we report the first-ever case of a fatal Leptospira spp. and H. canis coinfection in a two-month-old red fox cub with acute haemolytic anaemia, mild bronchopneumonia, intraalveolar haemorrhage, and tubulonephrosis. The presence of pathogenic Leptospira spp. DNA was detected in the kidney and lung tissues of the infected animal. In contrast to our previous knowledge, we believe that such fatal cases due to concomitant infection by Leptospira spp. and H. canis, especially in young animals, may commonly occur in nature. However, further studies are required to identify other factors that possibly contribute to the severity and the pathogenic effect of Leptospira spp. and H. canis infections in red foxes.

ANALYSIS THEORICO-PRACTICA DE VIRIBUS VIRUS FEBRIFERI, PESTIFERI, ATQUE SERPENTIN – THE FIRST MEDICAL ARTICLE BY AN AUTHOR FROM BOSNIA AND HERZEGOVINA

This review describes the first medical article written by an author from Bosnia and Herzegovina. The article was published by Fr. Franjo Gracić (1740-1799), in Latin, under the title: "Analysis theorico-practica de viribus virus febriferi, pestiferi, atque serpentin", and printed in Padua in 1795, translated as: "A Theoretical and Practical Presentation of the Effects of Fevers, Infectious Diseases, and Snake Poison". From today's standpoint, it may be said that it was a review article about some of the most frequent diseases of that time. The paper is of exceptional importance for the history of medicine in Bosnia and Herzegovina because it is the first documented medical article whose author was from Bosnia and Herzegovina. The paper contains observations of the course of diseases and treatment, in line with the medical insights of the time. The author refers to the authorities of that time, such as Samuel Auguste André Tissot, the Swiss physicist and doctor, Georg Bauer, the German doctor, and Lodovico Antonio Muratori, the Italian scholar, which makes this article a link between Bosnia and Herzegovina and the knowledge of the Europe of that time. This paper represents the beginning of medical writing in Bosnia and Herzegovina and has a very important place in the history of medicine in this country.

Major epidemiological features of first-ever ischemic stroke in Tuzla Canton, Bosnia and Herzegovina

BACKGROUND AND AIMS

Opacity of data on stroke for Bosnia and Herzegovina (B&H) is mainly due to the lack of a unified national stroke registry. This article aims to present updated epidemiological data on the etiology and risk factors for first-ever ischemic stroke in Tuzla Canton, B&H.

METHODS

This retrospective hospital-based study included all first-ever ischemic stroke patients admitted between January 1, 2018 and December 31, 2018 at the Neurology Department, University Clinical Center Tuzla.

RESULTS

First-ever ischemic stroke was diagnosed in 739 patients. Leading risk factors were hypertension (94%), diabetes mellitus (40.7%), and dyslipidemia (38.8%). The most common stroke subtypes were atherothrombotic (36.8%), cardioembolic (21.9%), and stroke of undetermined etiologies (19.2%). Mean NIHSS score at discharge was 13 (IQR 2-16), and favorable patient outcome (mRs ≤2) was recorded in 26.4% patients. Men (aOR 0.39; 95% CI 0.24-0.64) and younger patients (aOR 0.96; 95% CI 0.93-0.98) had significantly higher probability of having a favorable outcome at discharge. Dyslipidemia could be considered as a predictive factor for patient outcome (aOR 0.66; 95% CI 0.43-1.00).

CONCLUSIONS

More than 92% of our patients had at least one modifiable risk factor, with hypertension and diabetes being at the forefront. One out of four patients had become functionally independent at discharge, while hospital mortality was lower than in other Eastern European countries. The overarching goal should be steered toward the development of a national stroke registry, which should be used as a reference for all further stroke management activities.

Evaluation and selection of healthcare waste incinerators using extended sustainability criteria and multi-criteria analysis methods

Disposal of healthcare waste is a key issue of environmental sustainability in the world. The amount of healthcare waste is increasing every day, and it is necessary to adequately dispose of this kind of waste. There are various treatments for healthcare waste disposal, of which incineration of healthcare waste is one of the solutions. This paper suggests a model for selection of the type of incinerators that best solve the problem of healthcare waste in secondary healthcare institutions in Bosnia and Herzegovina. In the selection of incinerators, extended sustainability criteria were applied. Basic sustainability criteria: environmental, economic, and social criteria, were extended with the technical criterion. To assess which of the incinerators best meets the needs for healthcare waste collection, multi-criteria decision-making was used. For this purpose, a combination of two MCDA methods was applied in this paper, namely full consistency method (FUCOM) and compromise ranking of alternatives from distance to ideal solution (CRADIS). The FUCOM method was applied to determine the weights of the criteria, while the CRADIS method was applied to rank the alternatives. The best alternative of the six alternatives used is A2 (I8-M50), followed by alternative A1 (I8-M40), while the worst ranked alternative is A5 (I8-M100). These results were confirmed by applying the other six methods of multi-criteria analysis and the performed sensitivity analysis. The contribution of this paper is reflected through a new method of multi-criteria analysis that was used to solve decision-making problems. This method has shown simplicity and flexibility in operation and can be used in all problems when it is necessary to make a multi-criteria selection of alternatives.

Household transmission of SARS-CoV-2: a prospective observational study in Bosnia and Herzegovina, August-December 2020

•

The overall severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) secondary attack rate in this study was 17%.

•

Adults were more likely to be secondary cases than children.

•

Particular care should be taken if primary cases present with cough and rhinorrhoea.

•

Kissing a SARS-CoV-2 case or sharing a meal with a SARS-CoV-2 case increased the risk of infection.

•

Reducing contact in the household immediately is key to prevent onward transmission.

Background

The secondary attack rate (SAR) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was estimated, and the risk factors for infection among members of households with a coronavirus disease 2019 (COVID-19) index case were identified to inform preventive measures.

Methods

Between 3 August and 19 December 2020, a household transmission study was implemented based on a standardized World Health Organization protocol. Laboratory-confirmed cases of SARS-CoV-2 infection were recruited through the federal COVID-19 database. Trained contact tracers interviewed index cases and household members to collect information on demographic, clinical and behavioural factors. Contacts were followed up for 28 days to identify secondary infections. SAR was estimated and odds ratios (OR) were calculated for risk factors for transmission.

Results

In total, 383 households and 793 contacts were included in this study. The overall SAR was 17% [95% confidence interval (CI) 14–21]. Contacts had higher risk for infection if the primary case had both cough and runny nose (OR 4.31, 95% CI 1.60–11.63), if the contact was aged 18–49 years (OR 4.67, 95% CI 1.83–11.93), if the contact kissed the primary case (OR 3.16, 95% CI 1.19–8.43), or if the contact shared a meal with the primary case (OR 3.10, 95% CI 1.17–8.27).

Conclusions

These results add to the global literature by providing evidence from a middle-income setting. Standard preventive measures in households with positive cases remain critical to reduce transmission.

COVID-19 Impact on Access and Performing Dental Care in Bosnia and Herzegovina

Background:

The world was struck with a pandemic accompanied by maybe one of the most popular words out there right now, which is COVID-19. It has affected every aspect of life imaginable, especially in the medical sector particularly in our case dental care.

Objective:

This study goes on to analyse and assess the impact of COVID-19 on dental care in Bosnia and Herzegovina, varying from the staff, patients, supplies/equipment, and finances.

Methods:

An online survey and over-the-phone surveys were conducted, bringing in raw information to help with this study.

Results:

In total there were 10 different dental offices that information was obtained from. About 90% say that the pandemic has affected their patient flow, obviously due to some restrictions and regulations. And 60% say that the cost of PPE has increased since the pandemic started, while 40% said otherwise. Other data can be found in the rest of the study.

Conclusion:

Entering into the pandemic, dental practices quickly started to realize the seriousness of this situation, changing the way they do normal everyday work to accustom to this “new norm”. During such a problem, both sides have to participate to act upon accordingly to bring health and safety for everyone.

Pharmacists' clinical knowledge and practice in the safe use of contraceptives: real knowledge vs. self-perception and the implications

BACKGROUND

Pharmacists are often the first healthcare professionals that patients contact with their illnesses and requests for medical information, which is enhanced following the recent COVID-19 pandemic. Community pharmacists are expected and required to possess a broad spectrum of knowledge and skills. Self-assessment of these competencies is needed for their self-improvement.

PURPOSE OF THE STUDY

To assess pharmacists' clinical knowledge and practice in the safe use of contraceptives, and to compare the scores obtained by external observation with pharmacists' self-assessment of their knowledge as well as investigate the significance of preceptorship experiences. Contraceptives was chosen as the subject area in view of high rates of abortions as a means of contraception in Bosnia and Herzegovina.

METHODS

A questionnaire approach was used. The questionnaire included the following: the first domain contained two case scenarios (safe use of contraceptives), which evaluated clinical knowledge, a second domain in which pharmacists self-assessed their knowledge to resolve cases from the first domain and a third domain that measured the demographics of pharmacists (including experience in preceptorship). Dispensing practice was evaluated in the second domain. The questionnaires were distributed to a convenient sample of 100 pharmacists at the Annual Meeting of Bosnia and Herzegovina Pharmacists. The results were presented as counts (%). The groups (preceptors and non-preceptors) were compared using Mann-Whitney U test, paired assessments were analyzed by Wilcoxon signed-rank test and Spearman's correlation was used to assess the correlation between variables.

RESULTS

Of the 100 pharmacists invited to participate, 84 completed the questionnaire (84 % response rate). There was no agreement between pharmacists' real knowledge (average score - case 1: 2.71, case 2: 3.3) and their self-assessment (average score - case 1: 3.77, case 2: 3.91). There was no statistically significant difference in the actual knowledge of pharmacists (experienced/non-experienced in precepting), while the difference in the self-assessment was significant between these two groups.

CONCLUSION

Pharmacists appear to overrate themselves, which leads to self-enhancement bias, in which the experience in precepting has some influence. Pharmacists' capability in performing an objective self-assessment of their clinical knowledge needs to be carefully studied in the future to fully benefit patients.

Prevalence of rare F5 variants in general population from Bosnia and Herzegovina

Human gene F5, encoding coagulation factor V, was previously reported to be highly polymorphic. Apart from FV Leiden, several other rare variants have been detected in clinical practice and associated with thrombotic events, especially in cases when patient's phenotype and FV Leiden genotype were not in agreement. In this study, the prevalence of 17 rare F5 variants has been studied on a sample of 130 healthy adult individuals from the general Bosnian-Herzegovinian population. DNA was isolated from buccal swab samples, while genotyping was performed using MALDI-TOF MS method. The results have shown that Asp2194Gly and Met2120Thr are polymorphic in the study population with minor allele frequencies of 0.077 and 0.073, respectively. Additionally, these two variants were mutually exclusive with FV Leiden and none of them was positively associated with participants' family history of cardiovascular or cerebrovascular diseases. While the obtained results are in agreement with previously reported data for the general Caucasian populations, it is worth noting that only two rare F5 variants were detected in the study population, albeit at considerable frequencies. Still, scientific information on rare F5 variants is rather scarce and further studies aiming to assess functional importance of these variants, as well as their role as prothrombotic factors are necessary.

Crenobiont, stygophile and stygobiont molluscs in the hydrographic area of the Trebišnjica River Basin

In the paper the crenobiont, stygophile and stygobiont malacofauna of the karst area of Popovo Polje around Trebinje (Eastern Herzegovina, BiH) is presented. The materials were collected from springs, caves and interstitial habitats (with a Bou-Rouch pump) at 23 localities. The following species were found: Pisidium cf. personatum A.W. Malm, 1855, Theodoxus callosus (Deshayes, 1833), Sadleriana fluminensis (Küster, 1852), Radomaniola curta (Küster, 1852), Radomaniola cf. bosniaca (Radoman, 1973), Kerkia briani Rysiewska & Osikowski, 2020, Montenegrospeum bogici (Pešić & Glöer, 2012), Litthabitella chilodia (Westerlund, 1886), Travunijana vruljakensis Grego & Glöer, 2019, a new genus and species of the Sadlerianinae, Emmericia ventricosa Brusina, 1870, Iglica cf. absoloni (A.J. Wagner, 1914), Plagigeyeria tribunicae Schütt, 1963, Paladilhiopsis arion Rysiewska & Osikowski, 2021, Valvata montenegrina Glöer & Pešić, 2008, Radix labiata (Rossmässler, 1835), Galba truncatula (O. F. Müller, 1774), Ancylus recurvus Martens, 1783, Ancylus sp. and the amphibiotic Succinea cf. putris (Linnaeus, 1758). The redescription of the genus Travunijana Grego & Glöer, 2019, applying the characteristics of shell, female reproductive organs and penis, is also presented. The new genus and species are described, based on the shell, penis, radula and fragmentary data on the female reproductive organs. For all species, the mitochondrial cytochrome oxidase subunit I (COI) is applied to confirm the determination; in the case of Travunijana and the new genus, the nuclear histone H3 locus is also used, in order to infer both their distinctiveness and phylogenetic relationships.

Testing the effects of Facebook usage in an ethnically polarized setting

Despite the belief that social media is altering intergroup dynamics-bringing people closer or further alienating them from one another-the impact of social media on interethnic attitudes has yet to be rigorously evaluated, especially within areas with tenuous interethnic relations. We report results from a randomized controlled trial in Bosnia and Herzegovina (BiH), exploring the effects of exposure to social media during 1 wk around genocide remembrance in July 2019 on a set of interethnic attitudes of Facebook users. We find evidence that, counter to preregistered expectations, people who deactivated their Facebook profiles report lower regard for ethnic outgroups than those who remained active. Moreover, we present additional evidence suggesting that this effect is likely conditional on the level of ethnic heterogeneity of respondents' residence. We also extend the analysis to include measures of subjective well-being and knowledge of news. Here, we find that Facebook deactivation leads to suggestive improvements in subjective wellbeing and a decrease in knowledge of current events, replicating results from recent research in the United States in a very different context, thus increasing our confidence in the generalizability of these effects.

Haplogroup Prediction Using Y-Chromosomal Short Tandem Repeats in the General Population of Bosnia and Herzegovina

Human Y-chromosomal haplogroups are an important tool used in population genetics and forensic genetics. A conventional method used for Y haplogroup assignment is based on a set of Y-single nucleotide polymorphism (SNP) markers deployed, which exploits the low mutation rate nature of these markers. Y chromosome haplogroups can be successfully predicted from Y-short tandem repeat (STR) markers using different software packages, and this method gained much attention recently due to its labor-, time-, and cost-effectiveness. The present study was based on the analysis of a total of 480 adult male buccal swab samples collected from different regions of Bosnia and Herzegovina. Y haplogroup prediction was performed using Whit Athey’s Haplogroup Predictor, based on haplotype data on 23 Y-STR markers contained within the PowerPlex® Y23 kit. The results revealed the existence of 14 different haplogroups, with I2a, R1a, and E1b1b being the most prevalent with frequencies of 43.13, 14.79, and 14.58%, respectively. Compared to the previously published studies on Bosnian-Herzegovinian population based on Y-SNP and Y-STR data, this study represents an upgrade of molecular genetic data with a significantly larger number of samples, thus offering more accurate results and higher probability of detecting rare haplogroups.

A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions

Vaccination coverage in the Federation of Bosnia and Herzegovina, in Bosnia and Herzegovina, has been declining since 2014. This qualitative study aimed to identify barriers and drivers to childhood vaccination for parents. The COM-B (capability-opportunity-motivation-behavior) model was the underpinning theoretical framework. Face-to-face interviews with 22 parents of fully (n = 6), delayed/partially vaccinated (n = 9) and unvaccinated (n = 7) children were conducted. Interviews explored individual factors (capability-knowledge and skills; motivation-attitudes, confidence and trust) and context factors (physical opportunity-information, access, health systems; and social opportunity - social support, norms). Data were analyzed in NVivo using content analysis exploring differences in COM factors by vaccination status and location. Parents of fully vaccinated children typically reported individual and context drivers to vaccination. They accepted vaccination, trusted health workers, and were content with services. Parents of delayed/partially vaccinated children fell into two subgroups: (1) Those who accepted vaccination and attributed delays to their organizational skills or frustration with appointment times. (2) Those fitting the profile of "vaccine hesitant" - generally valuing vaccination and health worker advice, yet with concerns often triggered by media/social media. Parents of unvaccinated children mentioned individual and context barriers to vaccination, notably significant concerns about safety, some distrust of health workers and resentment of mandatory vaccination. Urban/rural differences included urban parents being more likely to report experiences with vaccine shortages and very few had received information leaflets. The study identified complex and inter-related barriers and drivers to parents' childhood vaccination behaviors. These insights have informed the development of tailored interventions to improve coverage.

Lifestyle risk factors and comorbidities of cancer patients in a country with limited resources

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.

Kornelija Rakić: A Woman Doctor for Women and Children in Serbia and Bosnia and Herzegovina

This short biography focuses on the life and medical activities of Kornelija Rakić (1879-1952), a Serbian female pioneer of medicine from the then Hungarian province of Vojvodina, who acquired an MD from the University of Budapest in 1905. Rakić came from a humble background, and a Vojvodina Serbian women's organization enabled her to become a physician and pursue her social medicine mission. After a futile attempt to open a private practice as a "woman doctor for women" in Novi Sad in 1906, she successfully applied to the Austro-Hungarian provincial government in Sarajevo for the position of an official female physician in occupied Bosnia. Rakić began her career as an Austro-Hungarian (AH) official female physician in Bihać (1908-1912) and was transferred to Banja Luka in 1912 and to Mostar in 1917=1918. Kornelija Rakić stayed in Mostar after the monarchy collapsed in 1918 and continued to work as a public health officer in the service of the Kingdom of Serbs, Croats and Slovenes, founded in 1918. Subsequently, she served as the head of the "dispensary for mothers and children" at the Public Health Centre in Mostar, founded in 1929, where she practiced until her retirement in 1949. After World War II, Rakić served as Vice President of the Red Cross Society in Mostar. She received numerous awards and medals from the Austro-Hungarian Empire, the Kingdom of Yugoslavia and the Federal People's Republic of Yugoslavia. Kornelija Rakić died in Mostar in 1952 and was buried at the local Orthodox cemetery of Bjelušine. CONCLUSION: Kornelija Rakić (1879-1952) was the first Serbian female physician in Novi Sad, Vojvodina, and she was employed as an AH official female physician in Bihać (1908-1912), Banja Luka (1912-1917) and Mostar (1917-1918). After World War I, she participated in the establishment and expansion of public health institutions in Mostar and Herzegovina from 1918-1949 against the backdrop of the devastation of the two World Wars.

Knowledge, attitudes, and practices towards COVID-19 among residents of Bosnia and Herzegovina during the first stage of COVID-19 outbreak

Study design

A cross-sectional study conducted by an online questionnaire-based survey.

Methods

This study was conducted by an anonymous online questionnaire based on a Chinese study during the fifth week from the beginning of outbreak of COVID-19 in Bosnia and Herzegovina.

Background

In order to control the spread of COVID-19, prevent the crash of health care system and ensure well-being of its residents, Bosnia and Herzegovina has taken rigorous preventive epidemiological measures in the beginning of the pandemic. Currently the situation has dramatically changed. The aim of this study is to present knowledge, attitudes and practices at the beginning of the outbreak in Bosnia and Herzegovina when the spreading of COVID-19 was well controlled and provide useful information to policymakers at this challenging time.

Results

In total 1,201 respondents, predominantly female (943 or 78.5%), with a mean age 30.57±11.26, scored very high on the knowledge test with a mean score 9.13±1.90. Being male (β: -0.141, p<0.001) and aged >30 (β: -0.099, p=0.030) were associated with lower knowledge scores, while education level of bachelor's degree and above (β: 0.092, p=0.003), living in urban environment (β: 0.062, p=0.044) and being a student (β: 0.240, p<0.001) were associated with higher knowledge scores. Only 638 (53.1%) of the participants agreed that COVID-19 will be successfully controlled. The vast majority of the participants (1,092 or 90.9%) have not visited any crowded place and 1,043 (86.9%) wore masks when they were going out... Decreased exposure to crowded places [(OR=0.427, p<0.001);(OR=0.805, p<0.001)] and an increase of wearing a mask while leaving home [(OR=1.564, p=0.022);(OR=1.219, p<0.001)] were associated with female sex and higher knowledge scores, respectively. Age group 18-29 (OR=0.616, p=0.007) and living in rural environment (OR=0.600, p<0.025) were associated with not wearing a mask outside the home.

Conclusions

Our study suggests that residents of Bosnia and Herzegovina have had good knowledge, a relatively optimistic attitudes and appropriate practices towards COVID-19 during the first period of outbreak.

Red mark syndrome (RMS) in farmed rainbow trout: First report of outbreaks in Bosnia and Herzegovina

Red mark syndrome (RMS) is a non-lethal inflammatory skin disorder spreading in farmed adult rainbow trout (Oncorhynchus mykiss) and reported worldwide. The aetiology is still uncertain, but positive correlation was found between Midichloria-like organism and RMS-affected fish. Here, we describe the first cases of RMS in Bosnia and Herzegovina. The outbreaks under study occurred in two intensive farms during the late winter and spring of 2020. Affected fish showed signs of disease ascribable to RMS, confirmed by pathological and molecular examination.

Surveillance of the Second Wave of COVID-19 in Europe: Longitudinal Trend Analyses

BACKGROUND

The COVID-19 pandemic has severely impacted Europe, resulting in a high caseload and deaths that varied by country. The second wave of the COVID-19 pandemic has breached the borders of Europe. Public health surveillance is necessary to inform policy and guide leaders.

OBJECTIVE

This study aimed to provide advanced surveillance metrics for COVID-19 transmission that account for weekly shifts in the pandemic, speed, acceleration, jerk, and persistence, to better understand countries at risk for explosive growth and those that are managing the pandemic effectively.

METHODS

We performed a longitudinal trend analysis and extracted 62 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in Europe as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R.

RESULTS

New COVID-19 cases slightly decreased from 158,741 (week 1, January 4-10, 2021) to 152,064 (week 2, January 11-17, 2021), and cumulative cases increased from 22,507,271 (week 1) to 23,890,761 (week 2), with a weekly increase of 1,383,490 between January 10 and January 17. France, Germany, Italy, Spain, and the United Kingdom had the largest 7-day moving averages for new cases during week 1. During week 2, the 7-day moving average for France and Spain increased. From week 1 to week 2, the speed decreased (37.72 to 33.02 per 100,000), acceleration decreased (0.39 to -0.16 per 100,000), and jerk increased (-1.30 to 1.37 per 100,000).

CONCLUSIONS

The United Kingdom, Spain, and Portugal, in particular, are at risk for a rapid expansion in COVID-19 transmission. An examination of the European region suggests that there was a decrease in the COVID-19 caseload between January 4 and January 17, 2021. Unfortunately, the rates of jerk, which were negative for Europe at the beginning of the month, reversed course and became positive, despite decreases in speed and acceleration. Finally, the 7-day persistence rate was higher during week 2 than during week 1. These measures indicate that the second wave of the pandemic may be subsiding, but some countries remain at risk for new outbreaks and increased transmission in the absence of rapid policy responses.

COVID-19 in Northeast Bosnia and Herzegovina and patient's length of hospitalization

Background

Since the outbreak of COVID-19 pandemic, clinical data from various parts of the world have been reported. Up till now, there has been no clinical data with regards to COVID-19 from Bosnia and Herzegovina (B&H). The aim was to report on the first cohort of patients from B&H and to analyze factors that influence COVID-19 patient’s length of hospitalization (LOH).

Methods

This retrospective cohort study was conducted at Tuzla University Clinical Center (UKC), B&H. It involved 25 COVID-19 positive patients that needed hospitalisation between March 28th and April 27th 2020. The LOH was measured from the time of admission to discharge. Factors analyzed induced age, BMI, presence of known comorbidities, serum creatinine and O₂ saturation upon admission.

Results

The mean age was 52.92 ± 19.15 years and BMI 28.80 ± 4.22. LOH for patients with BMI < 25 was 9 ± SE2.646 days (CI 95% 3.814–14.816) vs 14.182 ± SE .937 (CI 95% 12.346–16.018 p < 0.05; HR 5.148 CI95% 1.217 to 21.772 p = 0.026) for ≥25 BMI. The mean LOH of patients with normal levels of O₂ ≥ 95% was 11.667 ± SE1.202 (CI95% 8.261 to 13.739; p = 0.046), while LOH for patients with < 95% was 14.625 ± SE 1.231 CI95% 12.184 to 16.757 p = 0.042; HR 3.732 CI95%1.137–12.251 p = 0.03). Patients without known comorbidities had a mean LOH of 11.700 ± SE1.075 (CI 95% 9.592–13.808), while those with comorbidities had a mean of 14.8 ± 1.303 (CI 95% 12.247–17.353; p = 0.029) with HR2.552.

Conclusion

LOH varied among COVID-19 patients and was prolonged when analyzed for BMI ≥25, comorbidities, elevated creatinine, and O2 saturation < 95%. Furthermore, risk factors for COVID-19 patients in B&H do not deviate from those reported in other countries.

Usage of students' potential in biomedical and health care research in Bosnia and Herzegovina

Objective

To provide relevant insight into the current degree of usage of the research potential of students of biomedical sciences in Bosnia and Herzegovina.

Method

The chosen data collection method was online surveying via Google search engine. The target group were students of biomedical sciences in Bosnia and Herzegovina. The surveying was conducted in July 2019, and responses were subjected to descriptive statistics.

Results

Although the majority of participants claimed that they were familiar with the seminar and scientific papers writing methodology and that the related course is available in their faculty’s curriculum, the quality of such courses may be questioned as the majority of study participants self-reported that they do not possess or did not posses necessary knowledge for writing and publishing a scientific paper. Also, the majority of respondents reported that they have never participated in any scientific research, which questions the involvement of students in scientific research in our country as well. More than half of respondents were actively reading scientific papers, but a third of them did not have that habit. Two-thirds of students reported that they have never attended any scientific event where they could learn more about the scientific research methods. Inadequate awareness of the importance of research, lack of students’ interest in making a research, and lack of knowledge were characterized as main obstacles in conducting scientific research according to survey responses.

Conclusion

Information obtained through research indicate that the student potential in scientific research in Bosnia and Herzegovina has not been used in its maximal capacity, requiring several steps to be taken towards its improvement.