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Background/Aim: Antibiotic use and resistance represent a growing public health issue, with a specific risk of uncontrolled use of antibiotics in children. The aim of the study was to examine differences in parental knowledge, attitudes and practices about antibiotic use in children between urban and rural areas of the Republic of Srpska. Methods: A cross-sectional study was conducted among 1459 parents of children under 6 years of age, out of which 1201 (82.3 %) lived in urban areas while 258 (17.7 %) lived in rural areas. The research is conducted among parents who brought their children to the selected primary healthcare centres and among parents of children in preschool institutions. Results: The majority of respondents (98.4 %) state that doctors are their main source of information. Only 61.2 % of respondents precisely know which drug is an antibiotic when offered different drugs and respondents from rural areas (54.3 %) more often (p = 0.012) gave more accurate answers when compared to respondents from urban areas (37.3 %). Among parents, 86 % agree with the statement that improper use of antibiotics reduces their effectiveness and leads to bacterial resistance, regardless of groups. More than a half of respondents (52.4 %) do not think that children with flu or common cold symptoms recover faster when they receive antibiotics, significantly more respondents from urban areas (p = 0.001). Respondents from rural areas significantly more often believe that antibiotics can produce harmful effects compared to respondents from urban areas (p = 0.049). Respondents from rural areas significantly more often think that antibiotic use can prevent complications caused by inflammation of the upper respiratory tract (p = 0.006). Parents from rural areas give their children antibiotics without a paediatrician's recommendation significantly more often (4.3 %) compared to respondents from urban areas (0.6 %) (p < 0.001). Conclusion: There are differences in parental knowledge, attitudes and practices regarding antibiotic use and antimicrobial resistance among parents in rural and urban areas. There is need for additional education of parents and for greater engagement of paediatricians in providing guidance and explanations regarding the use of antibiotics.

Background/Aim: The World Health Organization (WHO) declared the spread of a novel disease COVID-19 as a pandemic on 11 March 2020. As of 12 June, there have been more than 7.4 million COVID-19 cases and more than 418,000 COVID-19 deaths globally. This paper represents epidemiological analysis of the first 100 days of COVID-19 epidemic in the Republic of Srpska. Methods: Data of all COVID-19 cases confirmed in the Republic of Srpska between 4 March and 12 June were collected from epidemiological and laboratory testing reports obtained from the Public Health Institute of the Republic of Srpska. This cross-sectional analysis was carried out on a sample of 1,607 laboratory-confirmed COVID-19 cases, which included: summary of patient characteristics, examination of age distributions and sex ratios, calculation of case fatality and mortality rates, incidence rates analysis, epidemiological curve construction and subgroup analysis. Results: Over 100 days after the first case was confirmed, the total number of infected patients in the Republic of Srpska rose to 1,607 (31,471 persons had been tested). As of 12 June, 69.9 % of those cases has recovered. During that period there were 117 confirmed deaths (average age 72 years; 60.7 % males; 86 % older than 60 years; 94 % with at least one comorbidity). The sex ratio among the confirmed cases was 0.95:1 (48.7 % men vs 51.3 % women). Infections were less common in persons below 20 years of age (7.3 % of all confirmed cases) and the majority of the affected persons were in the group 40-69 years of age. As much as 86 % of all death cases occurred in persons older than 60 years (average age 72 years) and 94 % of all death cases had at least one underlying condition (mostly cardiovascular diseases, 79.5 %). Conclusion: Evaluating the clinical data of COVID-19 patients, finding the source of infection and studying the behavior of the disease is crucial for understanding of the pandemic.

Introduction. Healthcare-associated infections (HAI) are a global public health problem that exists in all health care systems and lead to very significant consequences. All health care systems are obliged to continuously improve preventive measures, which can reduce occurrence of HAI by 10 to 70 percent. First step in improving prevention is constitution of functional epidemiological surveillance over HAI. Aim of the study. The objective of this study was to show, through the point prevalence survey, the rates of HAI in surgical clinics of the University Clinical Centre of the Republic of Srpska (UCC RS), their most important epidemiological characteristics, the most frequently isolated microorganisms and their resistance to antibiotics. Material and methods. In this study, we used standardized methodology for the point prevalence survey of HAI and antimicrobial use, including case definitions established by the European Centre for Disease Control (ECDC). The study was conducted in October 2014 at the surgical clinics of the UCC RS, and it included a total of 196 patients. Results. The prevalence of HAI at the surgical clinics of the UCC RS was 11.7%. The most common localization of HAI were surgical site infections (60.8%). The most common isolated microorganisms were Acinetobacter spp., Enterococcus spp., Pseudomonas aeruginosa i Staphylococcus aureus. All isolated Acinetobacter and 50% ofisolated Pseudomonas were resistant to carbapenems, 50% of Staphylococcus aureus to methicillin, 50% Enterococcus spp. to vancomycin, and 40% Enterobacteriaceaeto cephalosporins, 3rd generation. Conclusion. The prevalence of HAI at the surgical clinics of the UCC RS is within the frame of the prevalence in developing countries. More attention must be given to this problem. The prevalence study may be the method of choice for HAI surveillanceat national level.

Introduction. Antimicrobial resistance is a very serious public health threat worldwide. The main cause of antimicrobial resistance is irrational use of antimicrobial drugs. The goal of the article is to analyze data on outpatient antibiotic consumption in the Republic of Srpska during the period from 2009 to 2014, to present outpatient consumption of the first six antibiotics (the fifth level of the ATC classification), and, finally, to compare the antibiotic use in Republic of Srpska in relation to the antibiotic use in European Union countries. Materials and Methods. Collection and analysis of data on drug consumption is done using ATC/DDD methodology, established by the WHO. Data are taken from the report on drug consumption and distribution in the Republic of Srpska during the period from 2009 to 2014, which are based on submitted data from pharmacies registered in the Republic of Srpska. Results. Results on outpatient antibiotic consumption in the Republic of Srpska, during the period from 2009 to 2014, indicate a total decrease by 3.41 DDDs/1000 inhabitants/day, with the exception of 2010 and 2013, when the antibiotic consumption was increased. In 2014, total outpatient antibiotic consumption in the Republic of Srpska was 31.2% lower than the average consumption in the European Union. During the period from 2010 to 2014, the European Union had a significant increase in antibiotic consumption, while antibiotic consumption in the Republic of Srpska had a tendency of falling. Conclusion. Presented results show a quantitative analysis of antibiotic consumption and provide insight into the outpatient use of antibiotics in the Republic of Srpska, and can be used for further pharmacoepidemiological analysis of antibiotic consumption, which would give a better insight into the therapeutic practice, with the aim of improving the rational pharmacotherapy in the Republic of Srpska.

Introduction. Osteochondroma is the most common type of benign bone tumor which appears in two forms, sessile and pedunculated. It accounts for 50% of all benign tumors of bone tissue with a double tendency towards male population. It is covered by cartilage cap of different thickness. The thickness of the cap over 30 mm can indicate a malign transformation into the secondary chondrosarcoma. Aim of the study. Determine if there is a correlation between epidemic characteristics of the patients, pathohistologic characteristics, thickness of the cartilage cap and biological behavior of the tumor. Patients and methods. Cross-sectional study included 37 patients which were diagnosed with osteochondroma in the period of 12 months, during the year 2014, at the Institute for pathology of Medical Faculty in Belgrade. The patients’ age, sex, localization, clinical manifestation and length of the case history were descriptively determined. The thickness of the cartilage cap was morphometrically determined on pathohistologic devices of re-sectioned tumors. Out of 37 patients with diagnosed osteochondroma, 3 of them (8%) had malign alteration of the cartilage cap. The thickness of the cartilage cap in all the 3 of them was over 30 mm, ranging from 68-120 mm. Relapse was found in 3 patients (8%). Discussion. The highest importance of this lesion comes from the fact that it is the most common bone tumor with high incidence and possibility for malign transformation of the cartilage cap into secondary chondrosarcoma which makes this tumor interesting for medical staff at the clinic and pathologists. Conclusion. The width of a cartilage cap, in correlation with clinical and radiology parameters, is a significant predictive parameter of biological behavior of osteochondroma.

Introduction: Sex workers (SW) represent the population exposed to extremely high risk of HIV (HIV - Human Immunodeficiency Virus) and other sexually transmitted infections. Poor socioeconomic conditions in the country, insufficient education, high unemployment and other factors lead to an increase in prostitution, which represents a high risk for the spread of HIV and other sexually transmitted diseases. Aim of the study: The aim of this research was to evaluate the prevalence of HIV/ sexually transmitted infections among SW in Bosnia and Herzegovina as well as to examine knowledge, attitudes and behaviour relating to HIV/sexually transmitted infections. The results were compared with the results obtained in researches conducted in 2008 and 2010. Material and Methods: Research was performed in 2012 as a bio-behavioral study that covered 199 sex workers in five cities of Bosnia and Herzegovina. Interviewing was done voluntarily, anonymously and confidentially, and after informed consent and counselling, a biological material (blood) for laboratory testing on HIV, hepatitis b, hepatitis c and syphilis was taken. The research shows the presence of risk behaviour among SW, mostly related to frequent change of partners and frequent unprotected sexual intercourses. Results: Only one third of respondents (36,7%) use condom during every sexual intercourse with a client, and 13% use it with a steady partner. A sexual intercourse after effects of consumption of alcohol-87,9% of respondents and of drugs-36,7% of respondents. Although there is a risk behaviour, only 11,1% think that the risk of HIV/sexually transmitted infections is high, but 12,6% think that there is no risk. Sex workers are 13,5 times more exposed to HIV infection than all the other women aged 15- 49. Results of laboratory testing indicate a low level of HIV/sexually transmitted infections among sex workers in Bosnia and Herzegovina. Conclusion: Although there is a relative progress in prevention of HIV/sexually transmitted infections among sex workers and more frequent testing on HIV/sexually transmitted infections comparing to earlier periods, these things are insufficient for the maintenance of a low level of infection. Further research at certain time intervals among this population would enable monitoring time trends of HIV epidemic in Bosnia and Herzegovina and would become a basis for the development of preventable programmes.

It has been verified that serum N-acetyl-β-D-glucosaminidase (NAG) activity is elevated in diabetes, but there are no reports about changes of the sialic acid (SA) content in the carbohydrate parts of NAG A form and its influence on total NAG activity changes in type 1 diabetes mellitus patients without and with secondary complications. NAG A forms were isolated, purified and characterized from the serum of 81 IDDM patients with and without secondary complications (retinopathy, polyneuropathy and nephropathy) and 25 healthy persons. The content of α-2,6-bound SA and isoenzyme patterns of purified A form, total NAG and A form activities were determined. In all diabetic groups, A form sialylation levels were 2-3.5 times lower compared to control, while their acidities (fractions with pI 4.25-5.1) increased, particularly with progression of secondary complications. Total serum NAG activities and percentages of A form were significantly higher (P

Methylglyoxal is a highly reactive α-oxoaldehyde with elevated production in hyperglycemia. It reacts with nucleophilic Lys and Arg side-chains and N-terminal amino groups causing protein modification. In the present study, the importance of the reaction of the Cys thiol group with methylglyoxal in protein modification, the competitiveness of this reaction with those of amino and guanidine groups, the time course of these reactions and their role and contribution to protein cross-linking were investigated. Human and bovine serum albumins were used as model systems. It was found that despite the very low levels of thiol groups on the surface of the examined protein molecules (approx. 80 times lower than those of amino and guanidino groups), a very high percentage of it reacts (25-85 %). The amount of reacted thiol groups and the rate of the reaction, the time for the reaction to reach equilibrium, the formation of a stable product and the contribution of thiol groups to protein cross-linking depend on the methylglyoxal concentration. The product formed in the reaction of thiol and an insufficient quantity of methylglyoxal (compared to the concentrations of the groups accessible for modification) participates to a significant extent (4 %) to protein cross-linking. Metformin applied in equimolar concentration with methylglyoxal prevents its reaction with amino and guanidino groups but, however, not with thiol groups.

Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. About ninety percent of patients with lupus are women between the ages of 20 and 40. The disease may affect only one organ system, and it also can be a multisystem and affect the skin, joints, kidneys, lungs, nervous system, and serous membrane. In the case report is presented a 38 year old patient with severe systemic lupus erythematosus, which adequately reacted to the treatment of mycophenolate mofetil.