1

First

BANJA LUKA INTERNATIONAL

MEDICAL CONGRESS

BLIMC 2019

16th – 19th May, 2019

BOOK OF ABSTRACTS

Faculty of Medicine University of Banja Luka

ABSTRACT BOOK BLIMC 2019

2

Publisher:

Faculty of Medicine Banja Luka

For publisher:

prof. dr Ranko Škrbić

Editors:

Milica Malešević Igor Lepir

Živko Ćetojević

Design of the first page:

Miloš Malešević

Number of prints:

150

ISBN:

978-99976-26-31-8

3

„The secret of getting ahead is getting started.“

Mark Twain

4

Table of contents

BLIMC 2019 Congress Programme....................................................... 7

Faculty of Medicine, University of Banja Luka...................................... 10

Organizating committe ........................................................................ 12

Ambassadors 2019 ............................................................................. 16

Recensents ........................................................................................ 18

ABSTRACTS ...................................................................................... 19 ORAL PRESENTATIONS I ............................................................. 20

Session 1 ........................................................................................ 20

O1S1.1| Dajana Marjanović - Morphometric parameters of the extraembryonic structures ........................................................... 20

O1S1.2| Katarina Radojević - Depression and level of nutrition among medical students ............................................................. 22

O1S1.3| Emilija Došlov – Comparative analysis of epidemiologic situation of SARI, ILI and ARI during influenza seasons 2017/18 and 2018/19 in the Republic of Srpska ........................................ 24

O1S1.4| Jelena Đurđević – Incidence and factors associated with seasonal influenza vaccination in outpatients .............................. 27

O1S1.5| Šemsudin Porčić – Assessment of antibiotic susceptibility of different probiotic strains ......................................................... 29

ORAL PRESENTATIONS I ............................................................. 31

Session 2 ........................................................................................ 31

O1S2.1| Marko Ivanković - Impact of interdialytic weight gain on left ventricular overload in patients on regular hemodialysis .............. 31

O1S2.2| Santa Strazdina – Early detection of acute kidney injury affected by fluid overload in patients undergoing cardiopulmonal bypass surgery ............................................................................ 33

O1S2.3| Irfan Corovic – IL-33/ST2 signaling is necessary for the development of liver fibrosis in Th2 dominant mice on high fat diet ................................................................................................... 35

O1S2.4| Stefan Kremenović – Assessment of peritoneal transport characteristics in patients on peritoneal dialysis ........................... 37

5

O2S1.5| Jasmina Hakmi – CASE REPORT: Oncology treatment of Sister Mary Joseph nodule .......................................................... 39

O2S1.6| Fatima Gondžo – CASE REPORT: Metastatic malignant melanoma ................................................................................... 42

ORAL PRESENTATIONS II ............................................................ 45

Session 1 ........................................................................................ 45

O2S1.1| Branka Dragišić – Outpatient utilization of antidepressants: a study from the Republic of Srpska, Bosnia nad Herzegovina .... 45

O2S1.2| Emina Ćorović – The influence of n-acetyl cysteine on cisplatin-induced anxiogenic effects in the open field test in rats .. 47

O2S1.3| Irma Mureškić – Comparison between the dissolution profiles of different paracetamol suppositories ............................. 49

O2S1.4| Jovana Perovic – The effect of the four-week treatment with nandrolone decanoate and swimming training on cardiodynamics in the isolated rat heart ....................................... 51

O2S1.5| Miljan Tešić – The effect of simvastatin on the apoptosis in cardiomyocytes in experimental sepsis ........................................ 53

O2S1.6| Tijana Stanojković – Analysis of ten-years long hospital antibiotics consumption: What to expect in the future? ................. 55

ORAL PRESENTATIONS II ............................................................ 57

Session 2 ........................................................................................ 57

O2S2.1| Dinko Osmančević – Arrhythmias in myocardial infarction with ST elevation and myocardial infarction without ST elevation . 57

O2S2.2| Santa Strazdina - D-dimere level correlation with transesophageal echocardiography finding in patients, with atrial fibrillation before cardioversion .................................................... 59

O2S2.3| Vanja Dragašević – Newborn screening of phenylketonuria in Vojvodina ....................................................... 61

O2S2.4| Mona Kostić – Risk factors of the first febrile seizures ... 63

O2S2.5| Stefan Spasić – Experiences of Neurology clinic of Military Medical Academy with Fingolimod in Multiple Sclerosis T ............ 65

O2S2.6| Bojan Tepić – Atrial fibrillation as a predictive factor on ischemic stroke outcome ............................................................. 67

6

O2S2.7| Mervana Halilović – The incidence of cervical cancer in Una-Sana Canton ....................................................................... 69

O2S2.8| Neda Šapić – Importance of risk factors for the occurrence and maintenance of chronic leg ulcers ......................................... 72

O2S2.9| Jelena Obradović – Pyoderma gangrenosum as a sign of internal disease: report of 44 patients .......................................... 74

O2S2.10| Nikola Miljković – Evaluation of life quality of students with acnes in relation to smoking status using DLQI questionnaire76

O2S2.11| Mirjana Janićijević – Injures of the neck and head of pedestrians in traffic acidents with fatal outcomes ....................... 78

O2S2.12| Tekula Tejashwini – Seasonal and chronobiological variation phenomenon associated with cardiovascular events occurrence - a retrospective study ............................................... 80

SCIENTIFIC JURY OF SESSIONS ..................................................... 82

WORKSHOPS LEADERS ................................................................... 83

OUR PARTNERS ............................................................................... 84

7

BLIMC 2019 Congress Programme

Wednesday, May 15th 2019

08:00- 20:00 - Registration of incoming guests

21:00 – Welcoming party and socializing

Thursday, May 16th 2019

08:00 – 10:00 – Registration

10:00 – 11:00 – Opening ceremony – BANSKI DVOR, Concert Hall

11:00 – 11:15 – Media Press Conference, BANSKI DVOR, Lobby

11:00 – 11:15 – South East European International Institute for

Sustainable Technologies (SEEIIST) - Presented by Minister of Science

of Montenegro Sanja Damjanovic, BANSKI DVOR, CONCERT HALL

11:15 - 12:45 – Plenary Lectures I, BANSKI DVOR, Concert Hall

1. Damijan Miklavcic, PhD - Electroporation based treatments and

therapies

2. Zimei Wu, PhD - Tumor Micro-Environment Sensitive Liposomes

for Targeted Drug Delivery

3. Natasa Przulj, PhD - New Algorithms for Unavailing Biomedical

Knowledge from Heterogeneous Omics Data

12:45 - 13:00 – Zoono in Bosnia and Herzegovina. Say NO to Germs!,

BANSKI DVOR, Concert Hall

13:00 – 14:00 – Lunch break – HOTEL BOSNA, Crystal Hall

14:00 – 15:30 – Oral presentations I – ANURS Academy of Science and

Art of the Republic of Srpska)

8

15:30 – 16:00 – Coffee break

16:00 – 17:30 – Workshop I – first part, MEDICAL FACULTY (Save

Mrkalja 14)

17:30 – 19:00 – Workshop I – second part, MEDICAL FACULTY (Save

Mrkalja 14)

21:00 – Social program

Friday, May 17th 2019

10:00 – 11:30 – Plenary Lectures – BANSKI DVOR, Concert Hall

1. Ervin Sejdic, PhD – Computational deglutition – A novel

computational field to understand swallowing and associated

disorders

2. Borut Strukelj, PhD – Pharmaceutical Engineering Of

Recombinant Probiotics – Novel Delivery System Of Advanced

Biological Medicines

11:30 – 12:30 – Springer Book Promotion: “Nanofood and Internet of Nano

Things” Authors: Mirjana Maksimović, Enisa Omanović – Mikličanin, Almir

Badnjević – BANSKI DVOR, Concert Hall

12:30 – 13:30 – Lunch break – HOTEL BOSNA, Crystal Hall

13:30 – 15:00 – Oral presentations 2 – ANURS (Academy of Science and

Art of the Republic of Srpska)

16:00 – 17:30 – Workshop II – first part, UKCRS (University clinical center

of the Republic of Srpska)

17:30 – 19:00 – Workshop II – second part, UKCRS (University clinical

center of the Republic of Srpska)

21:00 – Social program

9

Saturday, May 18th 2019

09:00 – 10:30 – Plenary lectures III – BANSKI DVOR

1. Hani Al Salami, PhD – Biotechnological advancement in drug

delivery and tissue engineering: Future prospective.

2. Goran Stojanovic, PhD - Design a fabrication of microfluidic chips

in different technologies for biomedical applications

10:45 – 12:15 – Workshop III – Željko Karan, MD, PhD - lecture, MEDICAL

FACULTY (Save Mrkalja 14)

12:30 – 13:30 – Lunch break – HOTEL BOSNA, Crystal Hall

13:30 – 15:30 – Movie – „The Faces of Lafora (2017)“ - A story about

mother from Banja Luka who moved the world to save her girls. MEDICAL

FACULTY (Save Mrkalja 14)

15:30 – 17:30 – Banja Luka site seeing (group 1)

17:30 – 19:30 – Banja Luka site seeing (group 2)

21:00 – Social program – Goodbye party – RUDI Night club (Kralja A. I.

Karađorđevića 103a)

Sunday, May 19th 2019

10:00- 10:45 Closing and awards ceremony – MEDICAL FACULTY (Save

Mrkalja 14)

10

Faculty of Medicine, University of Banja Luka

Banja Luka Faculty of Medicine has turned 41 this year, working

successfully as the oldest higher education institution of its kind in the

region.

It was first established on 17 March 1978, at the initiative of the University

of Banja Luka and by Decision No 01-012-33/78 (Official Gazette, 3/78) of

Banja Luka Municipal Assembly, with a view to educating university

degree experts holding the professional title of doctor of medicine and the

first lecture was held on 15 November 1978.

The Faculty of Medicine starts the initiative to establish the study program

Pharmacy following in the footsteps of the success of the study program

of medicine and dentistry. At the proposal of the University of Banja Luka,

the study program Pharmacy at Banja Luka Faculty of Medicine was

established on 17 July 1995 by Decision No UP-02-07/95 of the RS

Ministry of Education, Science and Culture for the profile of Master in

Pharmacy. Classes at this study program started in the academic year

1995/96.

In 2007, the Faculty of Medicine started the initiative to establish the Study

Program Health Care and Nursing, which was accomplished based on the

Decision of the RS Ministry of Education and Culture (operating license

No 07.23/602-3900/09). Classes at this study program started in the

academic year 2007/2008. The profile for which students are educated is

Bachelor in Health Care and Nursing.

As part of its activities, the Faculty of Medicine organizes and delivers

training and performs scientific research in order to educate and provide

11

professional development to graduates and postgraduates in medical

sciences. It organizes and performs scientific research for acquiring the

professional title of medical specialist and academic degree of master in

medical sciences and the academic degree of doctor in medical sciences.

The Faculty of Medicine perfects and develops the methods of scientific

research, organizes systemic monitoring of professional and scientific

achievements and prepares the staff for independent work in their

respective professions and in scientific research. The Faculty organizes

and provides continuing professional development for healthcare staff to

keep abreast of modern developments in the field and in particular it is

engaged in raising and professional development of young scientists and

teachers, in line with the Higher Education Reform. It also takes part in

scientific and research projects in all medical disciplines. It participates in

the project of reforming faculties of medicine in BiH in line with the Bologna

Declaration and the European Higher Education Reform.

Website: www.med.unibl.org

12

Organizating committee

It was a true challenge for us to create first ever intenational medical

students' congress in our city and faculty. We hope that we started a

tradition – strong enough to last for many more decades.

Organizating committee consisted of many smaller teams who worked

together to make all of this come to life. We thank our Faculty of Medicine

for enormous support.

President of OC BLIMC 2019,

Milica Malešević

OUR TEAM MEMBERS

PROFESSOR COORDINATOR – doc. dr Igor Sladojević

PRESIDENT OF OC BLIMC – Milica Malešević

PUBLIC RELATIONS Dajana Duka

COMMITTEE: Jelena Zrnić

Stefan Kremenović

Angelina Dulić

Bojana Lazić

dr Ivana Todorović

dr Kristina Rendić

FINANCES COMMITTEE: Igor Lepir

Slobodana Bogojević

13

AMBASSADORS Miloš Malešević

COORDINATING Jovana Draganović

COMMITTEE:

WORKSHOPS Sonja Trbojević

COMMITTEE: Jovan Markanović

Jovana Draganović

Anđela Arar

Angelina Dulić

SOCIAL PROGRAM Dajana Duka

COMMITTEE: Anđela Arar

Jovana Radonić

Angelina Dulić

VISAS COMMITTEE: Tatjana Grabovac

Sonja Trbojević

Stefan Kremenović

Angelina Dulić

dr Kristina Rendić

VOLUNTEER Živko Ćetojević

COORDINATOR:

COORDINATORS FOR Jelena Zrnić

RECENSION OF Bojana Lazić

ABSTRACTS: Angelina Dulić

Stefan Kremenović

14

ABSTRACT BOOK Milica Malešević

PREPARATION Igor Lepir

COMMITTEE: Živko Ćetojević

Miloš Malešević

CLOSING CEREMONY Branko Pejaković

COMMITTEE: dr Kristina Rendić

Milica Čivčić

COORDINATOR OF Nataša Šipraga

PROMOTION DURING

CONFERENCE:

AWARDS AND CERTIFICATES

COMMITTEE:

Nataša Šipraga

Nikola Markanović

Milica Malešević

PRESIDENT OF THE ALLIANCE OF STUDENTS OF THE MEDICAL FACULTY (SAVEZ STUDENATA MEDICINSKOG FAKULTETA):

Stefan Kremenović

PRESIDENT OF SRPSKA MEDICAL STUDENTS' INTERNATIONAL COMMITTEE – SAMSIC

Angelina Dulić

15

We are very thankful to all of our volunteers – this congress would not

be the same without you!

16

Ambassadors 2019

We thank our hardworking ambassadors for their work of promoting our

congress.

Aaron Alvares

University of Sofia, "St. Kliment Ohridski" Faculty of Medicine; Sofia,

Bulgaria

Abu Talha Bin Fokhrul

Sylhet MAG Osmani Medical College; Sylhet, Bangladesh

Anastasiia Falaeeva

South Ural State Medical University, Paediatric Faculty; Chelyabinsk,

Russian Federation

Basma Yahya

Faculty of Medicine, Al - Azhar University; Al Mokhazm Al Daem, Egypt

Bilal Zafar

Liary General Hospital; Karachi, Pakistan

Faizan Akram

The Islamia University of Bahawalpur, Faculty of Pharmacy and

Alternative Medicine, Punjab, Pakistan

Isa Mashkur

Chernivtsi Children's City Hospital; Chernivtsi, Ukraine

Isidora Janković

University of Niš, Faculty of Medicine; Niš, Serbia

17

Kevin Varian Marcevianto

Faculty of Medicine Universitas Indonesia; Cipto Mangunkusumo National

General Hospital; Jakarta, Indonesia

Leticia Viera

Faculty Governor Ozanam Coelho; Rio de Janeiro, Brazil

Marko Bojović

University of Novi Sad, Faculty of Medicine; Novi Sad, Serbia

Nataša Šukalo

Medical University of Innsbruck; Innsbruck, Austria

Nikola Stojković

University of Kragujevac, Faculty of Medicine Kragujevac; Kragujevac,

Serbia

Sameera Shafique Chowdhury

Chattagram Maa O Shishu Hospital Medical College; Chittagong,

Bangladesh

Slaven Jovanović

University of Montenegro, Faculty of Medicine; Podgorica, Montenegro

Velma Suljendić

University of Tuzla, Faculty of Medicine; Tuzla, Bosnia and Herzegovina

Zahra Mansouri

School of farmacy, Hamdan University of medical sciences; Hamadan,

Iran

18

Recensents

Academician prof.dr Snježana Milićević

Prof.dr Bogdan Zrnić

Prof.dr Branislav Gašić

Prof.dr Branislava Jakovljević

Prof.dr Janja Bojanić

Prof.dr Jelica Predojević Samardžić

Prof.dr Lana Nežić

Prof.dr Ljiljana Tadić – Latinović

Prof.dr Mira Spremo

Prof.dr Miroslav Petković

Prof.dr Nenad Lučić

Prof.dr Nenad Ponorac

Prof.dr Slobodan Spremo

Prof.dr Vesna Gajanin

Prof.dr Vlastimir Vlatković

Prof.dr Zdenka Gojković

Prof.dr Zoran Mavija

Doc.dr Aleksandra Salapura

Doc.dr Bojan Stanetić

Doc.dr Igor Sladojević

Doc.dr Irena Kasagić Vujanović

Doc.dr Milorad Vujnić

Doc.dr Nataša Stojaković

Doc.dr Snežana Petrović Tepić

Doc.dr Vesna Rudić Grujić

Doc.dr Zoran Vukojević

Dr sc Nina Rodić Vukmir

Mr Dalibor Nedić

19

ABSTRACTS

Oral presentations I

Session 1.............................................................................. 20

Session 2.............................................................................. 31

Oral presentations II

Session 1.............................................................................. 45

Session 2.............................................................................. 57

20

ORAL PRESENTATIONS I

Session 1

O1S1.1| Dajana Marjanović - Morphometric parameters of the extraembryonic structures Author: Dajana Marjanović, Jelena Miljković, Savina Vojvodić E-mail: dajana.marjanovic98@gmail.com Mentor: Assoc. Prof. Vesna Ljubojević Faculty of Medicine, University of Banja Luka Introduction The placenta and the umbilical cord are extraembryonic structures whose morphometry deserves further exploration because of a possible association with fetal growth restriction. Also, placental morphometry provides useful information for preparation of amniotic membrane. In recent studies, placental and umbilical cord morphometry have been performed using digital image analysis. Aim The aim of this study was to estimate morphometric parameters of placentas and umbilical cords using digital image analysis of delivered placentas. Materials and methods Within this study, the fifteen placentas after delivery were examined. The fetal surface of the placenta was photographed with the ruler in the field of view using a digital camera. The diameter and fetal surface area of the placenta and the umbilical cord diameter at the insertion site were measured digitally Using Image Analysis LAS V4.3 software. The results were analyzed by methods of descriptive statistics.

21

Results The average diameter of placentas, measured by using digital image analysis, was 183.94 mm ± 28.32 mm (mean ± standard deviation). The minimal placental diameter area was 146.816 mm and maximal was 251.558 mm. The placental surface area was 23317.13 mm2 ± 5635.59 mm2. The minimal placental surface area was 14303.52 mm² and maximal was 34349.28 mm². The umbilical cord insertion to the placenta was paracentral in 45.46% of analyzed placentas. The central insertion of umbilical cord was in 18.18% and marginal in 36.36% of analyzed placentas. The umbilical cord diameter at the insertion site was 22.46 ± 5.66. The minimal umbilical cord diameter at the insertion site was 12.69 mm and maximal was 30.63 mm. Conclusion Digital image analysis enables obtaining the morphometric parameters of the placenta and umbilical cords. The obtained morphometric parameters of the placenta and umbilical cord are comparable to previous studies and open further placental research directions. Keywords: digital imaging; morphometry; placenta; umbilical cord

22

O1S1.2| Katarina Radojević - Depression and level of nutrition among medical students

Author: Katarina Radojević, Emina Ćorović E-mail: radojevickatarina3@gmail.com Mentor: Prof. Nela Đonović Faculty of Medical Sciences University of Kragujevac, Kragujevac, Serbia Introduction A lot of studies indicate the correlation between the degree of nutrition and the onset of depression. Depression that occurs among students, as a particularly risky group, can cause difficulty in motivating and achieving appropriate results. Aim The aim of this study is to examine connection between level of nutrition and depression in the population of medical students in Kragujevac. Material and methods This research was carried out in the form of a descriptive cross section study, and 302 students of the Faculty of Medical Sciences participated in the research. The strength of the study was determined using the G-Power software. The nutritive status is determined by the BMI (BMI) in accordance with the recommendations of the World Health Organization. To assess the level of depression the Beck's scale-second edition was used . The chi2 test (SPSS 20.0) was used for the statistical analysis of the data. Results The highest percentage of respondents (0.76) were normally fed, 0.07 were malnourished, 0.16 transient and 0.007 obese. There was no statistically significant difference in the level of nutrition among the sexes (p = 0.076). Men were overweight over a large percentage. The highest percentage of subjects (0.71) was without signs of depression, 0.178 had

23

mild depression, 0.092 moderate and 0.02 severe depression. There was no statistically significant difference in the level of depression among the sexes (p = 0.183). Mild and moderate depression was more common in men, while severe depression was more common in women. In overweight they were more present: tearfulness , irritability, concentration difficulties and self-criticism, with a statistically significant gender difference in favor of women. Conclusion The results of this study have shown that there is no statistically significant correlation between the level of nutrition and level of depression among students. Keywords: obesity; depression; students

24

O1S1.3| Emilija Došlov – Comparative analysis of epidemiologic situation of SARI, ILI and ARI during influenza seasons 2017/18 and 2018/19 in the Republic of Srpska

Authors: Emilija Došlov1, Aleksandar Knežević, Angelina Dulić

E-mail: emilija.doslov@gmail.com

Mentor: asist. dr sc. med. Nina Rodić Vukmir2, Senior Teaching Assistant

1University in Banja Luka, Faculty of Medicine in Banja Luka, Banja Luka, Bosnia and Herzegovina

2Institute of Public Health of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina; Department of Epidemiology, Faculty of Medicine, University of Banja Luka

Introduction

Influenza surveillance season starts at 40th week of the current year and lasts until the 20th week of the following year, and all cases of influenza-like illness (ILI), acute respiratory infections (ARI) and severe acute respiratory infections (SARI) (1) are reporting. Flu or influenza is an infectious disease of the primary respiratory system caused by influenza virus and is transmitted by droplets. Severe acute respiratory infections (SARI) are defined as an acute respiratory infection with: history of fever or measured fever of ≥ 38 C° and cough; with onset within the last 10 days and requires hospitalization . Influenza like illness (ILI) is defined as an acute respiratory infection with: measured fever of ≥ 38 C° and cough; with onset within the last 10 days. These symptoms are similar or the same as in influenza, but the ILI trigger may be some other disease or a virus, not necessarily an influenza virus.

Aim

To show the epidemiological situation and compare incidence of SARI, ARI and ILI by the 5th and 11th weeks of 2018 and 2019 during the flu season 2017/18 and 2018/19 in the Republic of Srpska.

25

Materials and methods

The used data were obtained from the Institute of Public Health of the Republic of Srpska (PHI RS), which were delivered to the Institute from all the health centers and hospitals of the Republic of Srpska. Fifth week is taken as a reference for the peak of the season, while after the 10th week there is a decline in incidence. The data is processed in software package Office 2018.

Results

A total of 50.145 cases of SARI, ARI and ILI were reported in the season of flu 2017/18 (ended 5th week), which is 9.003 (15,2%) less than the first 5 weeks of the 2018/19 flu season. 37.681 cases (75,1%) were reported as ARI, 12.399 (24,7%) as ILI, and a total of 65 (0,1%) cases as SARI. In the season 2018/19 (ended 5th week), a total of 59.148 cases of SARI, ARI and ILI were reported. Of these, 45.498 (76,0%) cases were registered as ARI, 13.263 (22,4%) as ILI, and 387 (0,6%) cases, as SARI. An exceptional increase in the incidence of SARI in the 2018/19 season is noticeable in relation to the 2017/18 season, as much as 83,2%.In the influenza season 2017/18 (ended 11th week), a total of 77.642 SARI, ARI and ILI cases were reported, of which 56.247 (72,44%) were ARI, 21.242 (27,36%) were ILI and 153 (0,2%) were SARI.In the influenza season 2018/19 (ended 11th week), a total of 83.389 SARI, ARI and ILI cases were reported, of which 63.887 (76,61%) were ARI, 18.787 (22,53%) were ILI and 715 (1,12%) were SARI. Comparing data ended 11th week, it is concluded that in the current season 7.640 (13,58%) more cases of acute respiratory infections (ARI) have been reported. 2.445 (13,06%) less cases of flu-like illnesses (ILI) cases were reported in the current season. Severe respiratory infections (SARI) have been reported far more, 562 (467,3%) cases.

Conclusion

Comparing the peak of the 2018/19 influenza season with the peak of the 2017/18 influenza season, an increase in the number of people with respiratory diseases from the ARI, ILI, and SARI groups has been identified. The most alarming data are those related to severe acute respiratory infections (SARI), where a jump of 467,3% is noticeable. Most

26

affected people were middle-aged and elderly people, with numerous co-morbidities that influenced the severity of the clinical picture. The increase of SARI incidence may be attributed to a subtype of the virus that has made a lot of complications in those patients, and comparison of data from two seasons leads to the conclusion that the dominant subtype of the virus was the V/Yamagata influenza virus in the last season, while this season it was an influenza virus A (H1) pdm09. We should not ignore the fact that the previous two seasons, according to the Institute of Public Health of the Republic of Srpska, were much milder than expected.

Keywords: SARI; ARI; ILI; influenza, flu; respiratory infections

27

O1S1.4| Jelena Đurđević – Incidence and factors associated with seasonal influenza vaccination in outpatients Author: Jelena Đurđević E-mail: jelenadjurdjevic1995@gmail.com Mentor: Assist. Prof. Srđan Stefanović Department of Clinical Pharmacy, Faculty of Medical Sciences, University of Kragujevac

Introduction The flu is an acute and contagious respiratory illness caused by an influenza virus circulating through our planet. There are three types of influenza virus: A, B and C. Subtypes which occur among people are А (H1N1) and A (H3N2). Seasonal, one-year vaccination is the main method in prevention of influenza and its complications. Vaccination is primarily recommended in several target groups that have an increased risk of developing complications associated with influenza: children between the ages of 6 months and 5 years, adults 65 years and older, pregnant women, residents of nursing homes, health workers as well as people with a chronic illness. Aim The aim of this study is to examine the frequency of vaccination against the influenza virus, attitudes of patients who have been vaccinated and the relative importance of factors that can contribute to potential low incidence of vaccination. Materials and methods An observational, analytical, case-control study was conducted in Health Center in Kragujevac and Krusevac on a sample of 132 adult respondents who are in an outpatient regimen and have a high risk of developing complications associated with influenza (adults older than 65 years and patients with chronic conditions). Respondents were divided into two

28

groups: a group of cases-vaccinated (N=66) and a control group of non-vaccinated patients (N=66). The data was collected from medical records of patients and using a semi-structured questionnaire which consisted of questions about the respondents’ knowledge and attitudes towards vaccination, as well as the complications that can happen as a consequence of non-vaccination. The dependent variable (outcome) is the frequency of vaccination in patients at high risk for the occurrence of complications of influenza. Independent variables or confounding variables are social demographic and clinical characteristics of the patients: age, gender, number and type of associated chronic diseases, as well as patient’s responses to questions from the questionnaire. The connection of examined independent variables with the observed dichotomous outcome was determined by binary logistic regression. Results The profile of respondents had the following characteristics: predominantly female sex (57.6%) and a mean age of 64.32 years (SD±10.22). In the group of cases, 52 (78.8%) respondents were vaccinated according to the doctors' advice and the other 14 (21.2%) were vaccinated of their own accord, without consulting the doctor. Of all the respondents, 79 (59.8%) believe that the population should be more informed about vaccination. The higher age of the subjects (adjusted OR 1.091; 95% CI 1.041-1.144), prolonged disease duration (adjusted OR 1.086; 95% CI 1.009-1.168), as well as the fact that respondents were retired (adjusted OR 3.552; 95% CI 1.630- 7.742), consume cigarettes (corrected OR 4.781; 95% CI 1.889-12.101) and consider that vaccination is useful (adjusted OR 4.721; 95% CI 2.813-7.923) are significant factors that increase the chance that respondents will be vaccinated. Identifying the flu as a common cold (adjusted OR 0.117; 95% CI 0.048-0.288) is a significant factor that reduces the chance that patients will be vaccinated. Conclusion Respondents’ awareness about the flu as serious disease and vaccination in preventing it is still insufficient. More effort is needed to increase the influenza vaccination incidence among vulnerable at-risk populations. One of the main methods for solving this problem is better and more frequent briefing and raising awareness of patients about vaccination. Keywords: flu; influenza virus; vaccination; chronic patients; awareness

29

O1S1.5| Šemsudin Porčić – Assessment of antibiotic susceptibility of different probiotic strains

Author: Šemsudin Porčić, Nina Eraković, Dajana Duka Email: semsudin.porcic@gmail.com Mentor: doc. dr Maja Travar Faculty of Medicine, University of Banja Luka Introduction Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host. In the treatment of infectious diseases with antibiotic therapy, probiotic bacteria are commonly used in the prevention of diarrhea. Aim To assess antibiotic susceptibility of different probiotic strains, and to determine the effect of simultaneous use of probiotics and antimicrobial drugs. Methods Under anaerobic conditions, two probiotics of different composition were cultivated. The turbidity of a 0.5 McFarland standard was used for standardization of inoculum density. Antibiotic susceptibility of probiotics was performed by disk diffusion method on Mueller-Hinton agar. Susceptibility was tested to 12 most commonly used antibiotics in clinical practice. Results Our study showed statistically significant difference (p < 0,05) of antibiotic susceptibility, between different probiotic strains. Probiotic containing Lactobacillus acidophilus, Bifidobacterium animalis ssp. lactis, Enterococcus faecium was resistant to ampicillin, ceftriaxone, cefaclor, trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid, meropenem, amikacin, gentamicin, erythromycin, piperacillin/tazobactam, and

30

susceptible to ciprofloxacin and vancomycin. Probiotic containing Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum was susceptible to all tested antibiotics, except for trimethoprim/sulfamethoxazole. Conclusion Probiotic containing Lactobacillus acidophilus, Bifidobacterium animalis ssp. lactis, Enterococcus faecium was resistant to most antibiotics. Probiotic containing Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum was susceptible to most antibiotics that were tested, and should not be used simultaneously with these antibiotics. To achieve the optimum effect, it is recommended that probiotics should be administered after the completion of antibiotic therapy. Keywords: Lactobacillus; Bifidobacterium; probiotics; antibiotic resistance

31

ORAL PRESENTATIONS I

Session 2

O1S2.1| Marko Ivanković - Impact of interdialytic weight gain on left ventricular overload in patients on regular hemodialysis Author: Marko Ivanković, Nebojša Igrutinović E-mail: markoivanko2103@gmail.com Mentor: Full Prof. Dejan Petrović Clinic for urology, nephrology and dialysis, Clinical center Kragujevac, Faculty of medical sciences, University of Kragujevac Introduction Main factor for development of the cardiovascular disease and mortality of patients on regular hemodialysis is hypervolemia. Amount of volemia in patients treated with regular dialysis depends on the balance of intake, residual diuresis and removal of the liquid by the ultrafiltration process during the hemodialysis session. Recommendations for volume status estimation include: anamnesis, physical examination, and other diagnostic methods like serum natriuretic peptids concentration, chest X-ray, echocardiography, inferior vena cava ultrasound, chest ultrasound and bioimpedance spectroscopy. Aim The aim of the study was to determine the prevalence of elevated serum BNP concentrations, the percentage of interdiality vield (IDWG), the rate of ultrafiltration (UFR), and the rate of blood flow through the vascular approach (Qavf) on the BNP concentration in serum. Material and methods The study included 120 patients, 73 male and 47 female (62,43 ±10,16 years) who were on a chronic hemodialysis program for more than three

32

months. Depending on IDWG, patients were divided into two groups: patients with IDWG≥5% (load of the left heart chamber volume) and where

the IDWG5%. Depending on UFR patients were divided into two groups: patients with UFR≥10 ml/kg/h(haemodynamic instability of patients during

hemodialysis)and patients with UFR10 ml/kg/h. Depending on Qavf

patients were divided into three groups: patients with је Qavf500 ml/min,

patients with Qavf=500-1000ml/min and patients with Qavf1000ml/min (load of the left heart ventricule volume). Results Normal left ventricular function expressed as a BNP concentration of less than 1200 pg/ml had 71% of patients, while volume loading at a BNP concentration of greater than 1200 pg/ml had 29% of patients. As for other parameters, IDWG≥5% had 17% of patients, UFR≥10ml/kg/h had 34% of

patients and Qavf1000ml/min had 31% of patients. Although we obtained higher mean BNP values in groups with higher concentrations of given parameters, we did not get statistical significance(p<0.05). Conclusion The majority of patients on regular hemodialysis do not have left ventricular volume overload, nor hemodynamic instability during hemodialysis session. Although there is a certain influence of the observed parameters on the serum BNP value, they have not been shown to be sufficiently sensitive to an adequate assessment. Detecting and monitoring the most sensitive parameters for patients in high risk of developing cardiovascular complications enables appropriate treatment in adequate time and provides high level of survival rate and better life quality in patients with end-stage renal disease. Keywords: interdiality yield; BNP; volume load; hemodialysis

33

O1S2.2| Santa Strazdina – Early detection of acute kidney injury affected by fluid overload in patients undergoing cardiopulmonal bypass surgery Author: Santa Strazdina, Laura Bertecka Email: santa.strazdina@gmail.com Mentor: Assoc.prof. Eva Strīķe Rīga Stradiņš university, Rīga, Latvia Introduction Acute kidney injury perioperatively comply 40% of all acute kidney injury cases. Acute kidney injury increases mortality, significantly prolong hospital stay and raises financial burden. Cardiothoracic patients, who undergo surgery under cardio-pulmonal bypass have high risk of developing cardio-renal syndrome. It is considered, that significant risk factor for perioperative development of acute kidney injury in patients undergoing cardio-pulmonal bypass surgery, is cardio-pulmonal bypass duration and fluid overload. Aim The aim of this study is to determine early postoperative fluid overload importance on acute kidney injury and its detection. Material and methods This prospective, observational, single-center study comprised 47 patients undergoing cardio-pulmonal bypass surgery. We observed patients' diuresis, serum creatinine levels and how these indicators correlate with fluid balance during the surgery, within the first twenty-four hours after the surgery and central venous pressure. Results

We analysed 47 patients. The mean age of the patients was 66.79 (11.3) years from which 51.1% (n=24) were women. We observed tendency

34

towards correlation between second day serum creatinine and first postoperative day fluid balance (p=0.081). Statistically significant correlation was between second day serum creatinine and third to sixth postoperative hour central venous pressure values (p=0.028). Longer duration of cardio-pulmonal bypass caused higher postoperative serum creatinine results (p=0.049). Conclusion Assessment of fluid overload importance on acute kidney injury development, using serum creatinine assay is noninformative. It is possible, that changes in serum creatinine appeared late, because they correlate with previous day fluid overload, central venous pressure and diuresis values. Keywords: fluid overload; acute kidney injury

35

O1S2.3| Irfan Corovic – IL-33/ST2 signaling is necessary for the development of liver fibrosis in Th2 dominant mice on high fat diet Author: Irfan Corovic, Emina Corovic, Aleksandar Milosavljevic E-mail: ira.corovic@gmail.com Mentor: Asstist. Prof. Nemanja Jovicic Department of histology and embryology, Faculty of medical sciences, University of Kragujevac Introduction The role of IL-33/ST2 pathway in adiposity and obesity-associated liver pathology is incompletely defined. The objective of the study was to investigate whether ST2 gene deletion affects liver steatosis, inflammation and collagen deposition in mice in response to high-fat and a combination high-fructose/high-fat diet. Materials and Methods Male, 8-week old ST2 deficient (ST2-/-) and wild-type (WT) BALB/c mice were placed on high-fat diet (HFD; 60% kcal fat) or low fat diet (LFD; 10% kcal fat) for 24 weeks. After 24 weeks of high-fat feeding, one group of animals was placed on combination of high-fat diet with ad libitum access to a 30% fructose solution for another 4 weeks. No pure water was available to the mice given the fructose solution. Histological, immunophenotypic and gene expression analyses were performed. Results HFD-fed ST2-/- mice exhibited higher weight gain, amount of visceral adipose tissue (VAT) and higher percentages of adipose-tissue associated CD11c+ dendritic cells, IFNγ+, IL-17+ and CXCR3+ T cells compared to diet-matched WT mice, as well as lower percentage of F4/80+Arginase1+ M2 macrophages. However, in the absence of ST2 markedly reduced HFD-induced hepatic steatosis was accompanied with lower expression of CD36, LXRα and PPAR-γ. Decreased inflammatory

36

cell infiltration, number of CD68+ macrophages and frequency of CD11c+ dendritic cells in livers were also observed, as well as decreased levels of TNFα in sera. Further, lower collagen deposition in livers of HFD-fed ST2-

/- mice was associated with less numerous profibrotic CD11b+Ly6Clow

monocytes and CD4+IL-17+ T cells and lower procollagen α1, IL-33 and IL-13 mRNA expression in livers, and lower serum levels of IL-33 and IL-13. There were no difference in TGFβ gene expression in the liver as well as in serum level of TGFβ. Conclusion IL-33/ST2 axis is necessary in the development of liver fibrosis in Th2 dominant mice. ST2 deletion enhanced high-fat diet induced adiposity and adipose tissue inflammation, but attenuated hepatic steatosis, inflammation and fibrosis. Keywords: IL33/ST2; liver fibrosis; Th2

37

O1S2.4| Stefan Kremenović – Assessment of peritoneal transport characteristics in patients on peritoneal dialysis Authors: Kremenović Stefan1, Duka Dajana1, Kekerović Bojana1, Blagojević Jelena1

Email: stefan.kremenovic@student.med.unibl.org Mentor: prof. Vlastimir Vlatković1,2, PHD 1Faculty of Medicine, University of Banja Luka 2University Clinical Centre of the Republic of Srpska Introduction Peritoneal dialysis (PD) is an intracorporal artificial substitution of the renal function in which the peritoneum membrane is used as a dialysis membrane. There are several modalities of PD, and the two basic ones are continuous ambulatory PD (CAPD) and automatic PD (APD). The main factor for the choice of therapy is the transport characteristics of peritoneum, which are different from patient to patient. The peritoneal transport characteristics are assessed by use of the peritoneal equilibration test (PET). Aim By analyzing the initial values of PET data to determine the transport characteristics of the peritoneum in the group of patients treated with PD at the Department of Nephrology at the University Clinical Center of RS (UKC RS), and compare them with the selected therapeutic modality PD (CAPD / APD). Material and methods A retrospective monocentric section study covered 25 patients treated with PD in the period from 2009 to 2017. (14 men, 11 women, aged 23-76 years, median 57 years). Patients were given initial standard PET, using 2 L of dialysis 2.5% dextrose, taking blood samples and dialysis of the zero hour, after 10 min, 2 and 4 h, for the determination of urea, creatinine and glucose. The analyzes were performed at the Institute of Laboratory

38

Diagnosis of the UKC RS. The data are processed and presented with descriptive statistics. Results The most common basic disease of subjects was diabetes mellitus (DM). Out of the total number, 7 patients (28%) were diagnosed with DM. Patients were on dialysis from 3 to 121 weeks (medium 31 week). By identifying PET, it was found that most of the subjects were medium-sized transporter of urea and creatinine, as well as medium fast and slow for glucose, and medium slow for volume. The initial PET did not identify any patient as a quick transporter. 20 patients were treated by the CAPD method, while 5 patients were on the APD. Conclusion Based on the results of PET, the method of PD is selected for each patient individually. Most of the patients were in the group of medium-slow transporters, treated with CAPD. There were no fast transporters that were an absolute indication for the APD application. The reasons for the use of APD in the treatment of patients in this study were of a social nature (students and working people). Keywords: Peritoneal dialysis; nephrology

39

O2S1.5| Jasmina Hakmi – CASE REPORT: Oncology treatment of Sister Mary Joseph nodule Author. Jasmina Hakmi, Fatima Gondžo, Anes Pašić, Mervana Halilović E-mail: jasmina_hakmi@hotmail.com Scientific advisers : Semir Bešlija, Berisa Hasanbegović, Amina Jalovčić- Suljević, Emina Bičakčić- Filipović, Elma Kapisazović Mentor: Anes Pašić, PhD Faculty of medicine, Sarajevo; Oncology clinic, Clinical Center University in Sarajevo, BiH Introduction Sister Mary Joseph nodule or Sister Mary Joseph Sign refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen. Mechanism of spread of cancer to the umbilicus is unknown but proposed mechanisms include direct transperitoneal spread via lymphatic running along the obliterated umbilical vein, hematogenous spread or via remnant structures like the falciform ligament, median umbilical ligament or a remnant of the umbilical duct. Sister Mary Joseph nodule is associated with multiple peritoneal metastases and signifies a poor prognosis. A rare case of Sister Mary Joseph nodule, manifesting as ascites, cachexia and bleeding per rectum is presented without any primary tumor despite extensive search for the same. Case report A 56 years old female was referred first time to Oncology clinic in Sarajevo at March 2017 by recommendation of Gynecological- Oncology consilium. Analysis of pathohistological characteristics of abdominal mass biopsy from paraumbilical area showed adenocarcinoma serosum cutis metastaticum, which was the most probably ovarian etiology. Initial CA125 was increased, pretreatment CT of abdomen and pelvis showed expansive tumor mass at right hemiabdomen and pelvis size 108x158x125mm which is the most probably adnexal etiology, carcinomatosis of peritoneum, hepatomegaly and ascites. Retroperitonel

40

and mesenterial lymph nodes were increased, the largest was to 12mm. First line of oncology treatment was by TC protocol followed by antibiotics. After six cycles of chemotherapy reevaluation value of tumor markers and CT of abdomen and pelvis didn't show any signs of RD, so we decided to changed TC protocol to Gemox protocol. During therapy patient hadn’t any side effects. After six cycles of chemotherapy by Gemox protocol reevaluation CA125 CT of abdomen and pelvis didn’t show disease progression. Avastin was approved by Federal Health Insurance Institute of BiH from December 2017. Considering patient’s condition after 25 cycles of chemotherapy by Gemox protocol and six cycles of Avastin ordinaries decided to continue this therapy in these doses because reevaluation CT and tumor markers proved SD. Disscusion The term “Sister Mary Joseph nodule” is used to describe a malignant umbilical tumor usually associated with advanced metastasizing intra-abdominal cancer and generally indicating a poor prognosis. The nodule usually presents as a firm, indurate often vascular swelling which may be fissured or ulcerated and may have serous, mucinous, purulent or bloody discharge. It is usually irregular in shape, generally painless when palpated except if the overlying skin has ulcerated. It is typically less than 5 cm in diameter but occasionally enlarges enough to form a protruding tumor. Its occurrence is uncommon and as a first sign of malignancy is rare. The most common origins of Sister Mary Joseph nodule are: gastrointestinal (52%), gynecologic (28%), stomach (23%) and ovarian (16%) carcinomas. About 15-29% of all cases have an unknown origin (as depicted by the presented case) and 3% originate from the thoracic cavity. The presence of a Sister Mary Joseph nodule verified histological signifies advanced metastatic carcinoma and a poor prognosis with a survival time of 10 months (range 2-17 months) and inoperability. Treatment of established Sister Mary Joseph nodule is palliative as wide excision, surgery and radiotherapy have all proved ineffective. Nevertheless a Sister Mary Joseph nodule is a time tested, honored clinical sign emphasizing the importance of a careful physical examination of the abdomen. It still remains an interesting and useful diagnostic tool in modern medicine.

41

Conclusion The evaluation of an umbilical mass should be directed by suspicion of its being a metastatic deposit keeping in mind its potential to be either a primary malignant umbilical lesion or a benign disease. In a patient with a known malignancy an umbilical mass represents a spread or seeding of the primary tumor and thus can influence therapeutic decision making. CT scans and Fine Needle Aspiration Cytology (FNAC) of the tumor are invaluable in the diagnosis of Sister Mary Joseph nodule and help to exclude a primary benign umbilical neoplasm. In 14-33% of cases, umbilical metastases lead to the diagnosis of previously occult neoplasms. Conflict of Interests: Authors have no conflict of interests. Keywords: Sister Mary Joseph’s nodule; peritoneal neoplasms; neoplasm metastasis

42

O2S1.6| Fatima Gondžo – CASE REPORT: Metastatic malignant melanoma Author: Fatima Gondžo, Anes Pašić, Jasmina Hakmi, Mervana Halilović E-mail: gondzofatima@gmail.com Scientific Coordinators: Semir Bešlija , Maja Banjin , Amina Jalovčić- Suljević, Emina Bičakčić Filipović, Elma Kapisazović Mentor: Anes Pašić, PhD Faculty of medicine, Sarajevo, BiH Oncology clinic, Clinical Center University in Sarajevo, BiH Introduction Melanoma skin tumors are made of abnormal pigment cells (melanocytes) that have become cancer cells. These tumors are usually brown or black in color because the cells still make melanin. Melanoma is the most dangerous skin cancer because it’s more likely to spread if it isn’t found early. It has the potential to spread through the dermis to nearby tissues and other parts of the body. The deeper a melanoma grows into dermis, the higher risk of spreading through lymph vessels of blood vessels. This is why finding melanoma as early as possible is do important. Most people can be cured if melanoma is found and treated early. Case report A male patient 49 years old has been diagnosed malignant melanoma four years ago. Diagnosis was confirmed by histopathology, pT2, Breslow 3, Clark 4, without lymphovascular invasion. PET/CT after surgery was completely normal. From June 2015. to December 2016. there was no changes at dermatoscopy, melanin was negative in urine but LDH was increased and ultrasound showed few increased lymph inguinal nodes which were different sizes. There was no any other pathological changes in patient’s condition during this period. Third reevaluation PET/CT was done in November 2016., it showed new pathological lymph nodes in retroperitoneal area, in pelvic area next to artera illiaca communis, arteria illiaca externa and in inguinal area which was describes as reactive or possible meta. Ground glass opasicification of lung tissue was described

43

as possible reactive change or less possible as metastasis. Patient is BRAF positive (mutation was at V600E exon) so we decided to treat him by Vemurafnib. In first ten days patient complained very severe headaches. After ten days, skin rash appeared. Patient continued this therapy for three cycles. Because of head any foot syndrome II to III grade we decided to reduce dose of Vemurafenib. PET/CT in April 2017. showed complete morphological and metabolic regression of disease. In June therapy had to be paused because of paramedical reasons. Reevaluation PET/CT was done August 2017. It didn’t show any sign of disease. In January 2018. patient came for consultation because he complained very severe headaches and double visions. Emergency CT showed hemorrhagic metastatic mass at parieto- occipital area of brain size 32x26mm with perifocal edema and gently compression of occipital horn of right lateral ventricle. Analysis of pathohistological characteristics showed it was metastasis of melanoma. Reevaluation PET/CT after surgery didn’t show PD. After surgery, consilium indicated oncology treatment from March 2018. by combination of Cotellic and Vemurabenib. Twenty four hours after first dose patient got red skin rash which was in form of red little spots all over body so therapy was changed to Tafinlar and Mekinist. Patient continued this therapy with no severe drugs side effects except few episodes of fever. Reevaluation CT of abdomen and pelvis was done in August 2018. without signs of PD. In September 2018. he was admitted to Pulmology clinic “Podhrastovi” because of thromboembolism of right lung lobe. During hospitalization he had epileptic seizures and fracture of right malleolus. Recommendation for therapy after this hospitalization was Clexane in dose 40mg subcutaneously permanently and Exmal. Reevaluation CT of neurocranium was done in October 2018. and it was normal. Reevaluation CT of abdomen and pelvis was done in November 2018. This CT showed progression at size and number of lymph nodes in both inguinal areas. Reevaluation CT of lungs was done in November 2018. and it was normal. Reevaluation PET/CT was done in March 2019. This PET/CT didn’t show PD. Until April 2019. he got nine cycles of anti BRAF/MAK therapy. Disscusion Treatment options for patients with stage IV melanoma include immunotherapy, targeted therapy, chemotherapy, biochemotherapy, radiation therapy, surgery for isolated and limited metastases, and participation in clinical trials. Surgery remains the most effective treatment for malignant melanoma, especially in patients with hematogenous dissemination of disease, when it is resectable. A complete metastatic

44

workup is mandatory, including complete evaluation of specific signs and symptoms when present. Evaluation of patients with metastatic melanoma should always rely on the combination of appropriate clinical information and accurate workup that has to include chest and abdominal-pelvic CT scan, FNA or biopsy, brain MRI in the presence of neurologic symptoms, clinical suspicion of brain metastases or if results could influence decision, and serum LDH. In more advanced stages of the disease, stages III and IV, PET/CT scan can be useful to detect occult metastatic disease or to better characterize uncertain findings at CT scan. It has been also demonstrated that PET/CT scan can impact the decision making process and the decision made in patients with advanced melanoma PET/CT scan can be suggested prior to surgery in apparently resectable patients at high risk of disseminated disease. Conclusion Melanoma has a high malignant potential and can spread almost everywhere but complete surgical resection in patients with solitary metastasis appears to offer the best chance of long-term survival. Conflict of Interests: Authors have no conflict of interests. Keywords: melanoma; brain metastases; BRAF mutation; anti BRAF/MAK therapy

45

ORAL PRESENTATIONS II

Session 1

O2S1.1| Branka Dragišić – Outpatient utilization of antidepressants: a study from the Republic of Srpska, Bosnia nad Herzegovina Author: Branka Dragišić E-mail: brankadragisic@gmail.com Mentor: Prof. dr Svjetlana Stoisavljević Šatara University of Banja Luka, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina Introduction According to WHO, it is estimated that major depression would be the second most leading cause of disability in the world by 2020. Antidepressants are used in the treatment of major depressive disorder and other mental illneses, and constitute one of the most widely prescribed and costly medication classes. Aim The aim of this study was to analyse the utilization patterns of drugs acting on the nervous system (group N), especially antidepressants, among oupatients in the Republic of Srpska, between 2014 and 2016. Material and methods This is a retrospective study aimed at analysing outpatient utilization of drugs, with a focus on the utilization of drugs acting on the nervous system. Anatomical therapeutic chemical/defined daily dose methodology was used to monitor drug utilization. Data was given by the Public Health Institute of the Republic of Srpska.

46

Results The most highly used drug subgroups were analgetics, followed by psycholeptics and psychoanaleptics. Selective serotonin re-uptake inhibitor drugs, particulary sertraline, were most prescribed drugs in the group of antidepressants, and followed by fluoxetine, escitalopram, amitriptyline and maprotiline. Conclusion The observed tendency toward increased total drug utilization observed in our study is comparable to worlwide trends. The concerning fact is increased utilization of anxiolytics and antipyretic drugs. During the study period, utilization of antidepressants is constantly rising, particulary selective serotonin re-uptake inhibitor drugs, which are widely accepted as a drugs of first choise in the depression treatment. Keywords: drug utilization; drugs acting on the nervous system; antidepressants; ATC/DDD methodology; sertraline

47

O2S1.2| Emina Ćorović – The influence of n-acetyl cysteine on cisplatin-induced anxiogenic effects in the open field test in rats

Author: Emina Ćorović E-mail: emina.corovic1@gmail.com Mentor: Professor Gvozden Rosic, MD, PhD; Assistant professor Dragica Selakovic, MD, PhD Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Serbia Introduction Cisplatin is anticancer drug which is widely used in treatment of different types of malignancies, but clinical use is limited due to numerous adverse effects, including neurotoxicity. Toxicity of cisplatin is reported to be associated with an increased oxidative damage. In that sense, the antioxidant supplementation, as potentially useful in alleviating adverse effects caused by cisplatin, should be estimated. Aim The aim of this study was to examine the effect of N-acetylcysteine (NAC) on anxiogenic effects induced by cisplatin. Material and methods In this study male Wistar albino rats were used and they were divided in four groups (8 animals per group): control, cisplatin (7.5 mg/kg weekly, i.p.), NAC (500 mg/kg weekly, i.p.) and cisplatin + NAC group (cisplatin - 7.5 mg/kg weekly, and NAC - 500 mg/kg weekly, i.p.). All treatments lasted for two weeks. The open field (OF) test was used for the behavioral testing.

48

Results Cisplatin administration significantly decreased cumulative duration in centre zone (CDCZ) and the frequency to centre zone (FCZ) compared to control. NAC application, along with cisplatin therapy, reversed the values of those parameters to control levels, while NAC alone had no effect on those parameters. Conclusion The administered dose of NAC reduced the anxiogenic effect of cisplatin by means of the OF test parameters. Keywords: cisplatin; N-acetylcysteine; open field test; anxiety

49

O2S1.3| Irma Mureškić – Comparison between the dissolution profiles of different paracetamol suppositories Authors: Mureškić Irma1, Jevđenić Božana1, Račić Anđelka2, Bubić Pajić Nataša2

E-mail: irma.mureskic@hotmail.com Mentor: Ass. Lecturer Nataša Bubić Pajić 1 Department of Pharmacy, University of Banja Luka - Faculty of Medicine, Bulevar vojvode Petra Bojovića 1A, 78000 Banja Luka, Bosnia and Herzegovina

2 Department of Pharmaceutical Technology and Cosmetology, University of Banja Luka - Faculty of Medicine, Bulevar vojvode Petra Bojovića 1A, 78000 Banja Luka, Bosnia and Herzegovina Introduction Dissolution test is a biopharmaceutical test used to determine in vitro drug release. Dissolution profiles of paracetamol suppositories containing 120-200 mg of the drug, on fatty base, obtained from four manufacturers (A, B, C, D) were examined. Aim The goal of this study was to compare dissolution profiles of four different paracetamol suppositories and to determine potential differences in the release due to different pharmaceutical formulations. Materials and methods The dissolution study was performed according to the procedure described in The United States Pharmacopoeia using basket method, with rotational speed of 75 rpm and temperature of dissolution media 37 ± 0.5 °C. Two types of media were used: purified water and phosphate buffer (pH 7.4). Samples were withdrawn after 15, 30, 45, 60 and 90 minutes, filtered and analysed spectroscopically at 243 nm. The concentrations of the drug were determined using calibration curves and the percentages of dissolved drug were calculated.

50

Results The most reproducible results were observed for suppositories A and D, where the total dose of the drug (103.2% and 104.5%) was dissolved in purified water after 90 minutes, while the release in the phosphate buffer was lower, with 97.88% and 88.92% for products A and D, respectively. Suppositories C produced paracetamol release of 63.58% in purified water and 52.7% in phosphate buffer. The greatest variation in the drug release was observed for suppository B, reaching 6.94% and 62.14% of paracetamol dissolved, in puriefied water and phosphate buffer, respectively. Conclusion Based on the results, tested suppositories showed significant differences in dissolution profiles. It can affect bioavailability and consequently a therapeutic response. Two of the preparations dissolved the full dose of the drug in the water, and slightly less in the phosphate buffer solution. The third preparation showed modest drug release in both media, and the fourth preparation exhibited a great variation in the released drug amount. These differences occur mostly due to technological factors, such as different formulation, manufacturing processes and the composition of the dissolution medium. Keywords: paracetamol; suppository; dissolution test; drug release

51

O2S1.4| Jovana Perovic – The effect of the four-week treatment with nandrolone decanoate and swimming training on cardiodynamics in the isolated rat heart Author: Jovana Perovic E-mail: jperovic95@yahoo.com Mentor: TA Jasmina Sretenovic Institute of Physiology, Faculty of Medical Sciences, University of Kragujevac Introduction Nandrolone decanoate is one of the most famous anabolic androgenic steroid (AAS). Despite the fact that its use is forbidden in sports, today it is one of the most commonly abused AAS among recreational players, young people and athletes such as bodybuilders, cyclists, and swimmers to improve their physical performance. The effects of the use of nandrolone decanoate on the heart muscle haven’t been sufficiently investigated, yet. On the other hand, endurance training is known to cause changes in the morphology and function of the heart, including the increase in the size of left ventricular, wall thickness and increased mass of the heart, known as an “athlete’s heart”. Aim The aim of this study was to examine the effects of four-week administration of nandrolone decanoate alone or combined with swimming training on cardiodynamics and coronary flow in isolated rat heart. Material and methods The study included 32 Wistar albino male rats (aged 10 weeks, body weight 250 ±50 grams), randomly divided into 4 groups: control group (T-N-), nandrolone (T-N+), training (T+N-) and nandrolone with training (T+N+). The nandrolone positive (N+) group received nandrolone decanoate in the dose of 20mg/kg b.w. once a week subcutaneously. The training positive groups (T+) were swimming 4 weeks in the pool, 1h per day, and 5 days per week. After 4 weeks of the experimental protocol, the

52

rats were sacrificed. The isolated hearts were perfused according to the modified Langendorff technique at gradually increasing the values of coronary perfusion pressure (40-120 cmH2O). Using the sensor placed in the left ventricle, we registered the maximum and minimum rate of the left ventricle pressure development (dp/dt max and dp/dt min), systolic and diastolic left ventricular pressure (SLVP and DLVP) and heart rate. Coronary flow was measured fluorimetrically. Results Self-administered nandrolone has not led to a change in the minimum and maximum rate of the left ventricle pressure development, even at different coronary perfusion pressures. In the T+N+ group, dp/dt max was higher from pressure 80 to 120 cm H2O. No increase in SLVP is seen in the observed groups except in T+N+ from pressure 80-120 cm H2O, but a slight increase in DLVP was noticed in all groups, although it was very statistically significant in T+N+ group. We recorded a slight increase in the coronary flow due to coronary perfusion pressure of 80 cmH2O in the T+N+ group. In T+N- coronary flow was lower than the control group. Combination of nandrolone and swimming training led to lower HR compared to the control group, but self-administrated nandrolone hasn’t led to a change in the heart rate compared to the control group. Conclusion Self-administration of nandrolone decanoate did not lead to significant changes in the function of rat’s heart. Nandrolone decanoate combined with training had a positive effect on cardiac muscle function and perfusion. Keywords: nandrolone decanoate; cardiodynamics; isolated heart; rat; training

53

O2S1.5| Miljan Tešić – The effect of simvastatin on the apoptosis in cardiomyocytes in experimental sepsis Author: Miljan Tešić E-mail: miljantesic994@gmail.com Mentor: Prof. dr Lana Nežić University of Banja Luka, Banja Luka, Bosnia and Herzegovina

Introduction Bacterial endotoxin (LPS) leads to cardiac dysfunction and death through the induction of inflammatory processes and apoptosis in heart tissue. Apoptosis, the ever-present process and the way in which the cells normally die, has its own indicators, or markers, by which it is recognized. Cytochrome C, marker of the internal pathway of apoptosis, and FADD, marker of the external pathway of apoptosis, are analyzed in this experiment. Also, as a marker of apoptosis, Caspase 3 was analyzed, a specific effector protease that regulates the proteolysis of cellular proteins during apoptosis itself. Simvastatin, HMG CoA reductase inhibitor, besides its leading role in lowering cholesterol levels, has pleiotropic effects, of which the most significant for this experiment is the anti-inflammatory effect, which is accomplished by affecting cells and mediators of inflammation, as well as their possible anti-apoptotic effect. Aim In this research, apoptosis and its markers in cardiomyocytes were studied before and after the administration of Simvastatin to confirm the cytoprotective effect of this drug. Materials and methods In situ investigations were carried out on paraffinic sections of the Wistar soybean myocardial tissue, of which the first was the control group, the second group was treated with LPS 30mg/kg, and the third group received pretreatment of Simvastatin 40mg/kg before treatment with LPS.

54

Results Compared to those groups, significant differences in the expression of each of the three markers of apoptosis were observed. In the LPS-treated group, the index of antigen-positive cells for Cytochrome C was in average 62.1% and FADD 67.9%, while in the group with Simvastatin pretreatment expression for the same markers of apoptosis was 37.5% and 42.4%. The index of antigen-positive myocytes for Caspase 3 was 51.2% in the LPS-treated group and 21.6% in the group with Simvastatin pretreatment. Conclusion It has been found that Simvastatin has a cardioprotective effect in an experimental endotoxin-induced sepsis, which is most likely achieved through the initiator of the internal and external pathway of apoptosis. Keywords: LPS; Simvastatin; Cytochrome C; FADD; Caspase 3

55

O2S1.6| Tijana Stanojković – Analysis of ten-years long hospital antibiotics consumption: What to expect in the future?

Author: Tijana Stanojković, Stefan Spasić E-mail: stanojkovictijana96@hotmail.com Mentor: Assistant Lecturer Aneta Perić Military Medical Academy, University of Defence, Belgrade, Serbia Introduction Monitoring of consumption antibiotics and their rational use are crucial for preventing the formation of resistant microorganisms. Aim The aim of the study is to demonstrate the consumption of parenteral antibiotics in the Military Medical Academy (MMA) for a period of ten years, and to predict the consumption by 2020. Material and methods A retrospective analysis of consumption of antibiotics for systemic application, in period 2009-2018. in the MMA. Consumption is expressed in defined daily doses per 100 patient days (DDD / 100 BD) according to Anatomical-Therapeutic Chemical Classification-ATC), using the ATC/DDD index for 2018. Average consumption is represented as the mean ± standard deviation. The prognosis of the time series was carried out using the mean values of the data for each antibiotic group, for each analyzed year. Based on a medium-term trend over a ten-year period, we anticipated the future consumption of antibiotics for the period 2019-2020, using the ARIMA prediction model. Results In the analyzed 10-year period, the consumption of antibiotics was 4.16 ± 3.81 DDD / 100BD. The most commonly used were cephalosporins. Their

56

average consumption was 18.67 ± 6.65DDD / 100BD, with a maximum value of 36.38DDD/100BD in 2010. The use of metronidazole and carbapenems shows a trend of growth with a maximum consumption of 2018 (11.15 DDD / 100BD and 8.32 DDD / 100BD). The results of consumption forecasting show an increase in the use of carbapenems, metronidazole and glycopeptides, and a decrease in the consumption of penicillins and quinolones by 2020. Conclusion The use of antibiotics must be carefully monitored in order to preserve their efficacy. The results of spending forecasts indicate a potential increase in hospital consumption of broad-spectrum antibiotics. Keywords: antibiotics; hospital consumption

57

ORAL PRESENTATIONS II

Session 2

O2S2.1| Dinko Osmančević – Arrhythmias in myocardial infarction with ST elevation and myocardial infarction without ST elevation Author: Osmancevic Dinko1

Mentor: Tamara Kovacevic-Preradovic2, MD, PhD 1University of Banja Luka, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina 2University Clinical Centre of the Republic of Srpska, Department of Cardiology, Banja Luka, Bosnia and Herzegovina Introduction Arrhythmias are the most common complications of acute coronary syndrome which contribute to the mortality of the clinical entities myocardial infarction with ST elevation (STEMI), without ST elevation (NSTEMI) and unstable angina pectoris (NAP). Aim To show the frequency of occurrence of single arrhythmias within STEMI and NSTEMI and to show if there is a causal relationship between the arrhythmia and the type of acute myocardial infarction. Materials and methods 198 electrocardiograms and coronarographies of patients admitted to the coronary unit of the University Clinical Centre in the year 2017. were reviewed. Descriptive statistics using Excel 2016, and statistical hypothesis testing using Social Science Statistics.

58

Results Out of 198 patients in total, 158 (79,8%) patients had STEMI and 40 (20,2%) had NSTEMI. Arrhythmias were found in 84 (53,16%) patients with STEMI and in 22 (55%) patients with NSTEMI. 106 (53,54) patients had an arrhythmia of any kind. Out of a total of 122 arrhythmias, 99 (81,15%) where found in STEMI and 23 (18,85%) in NSTEMI. The most frequent arrhythmia was sinus tachycardia with a total of 32 (26,23%), 27 (27,27%) in STEMI and 5 (21,74%) with NSTEMI. Atrial fibrillation occurred 15 (12,29%) times, 9 (9,09%) in STEMI, and 6 (26,08%) in NSTEMI which resulted as a statistically significant finding (χ2=4,9997, p=.0254 kod p<.05). Ventricular fibrilation was found 8 (6,56%) times in total. There were also 4 (3,28%) ventricular tachycardias, but only in STEMI. Other arrhytmias showed up 63 (51,64%) times. Conclusion Sinus tachycardia and sinus bradycardia where the most frequent arrhytmias, and there is no causal relationship between the ocurence of the arrhythmias and the type of acute coronary syndrome. Atrial fibrilation was significantly increased in NSTEMI. Keywords: acute coronary syndrome; arrhythmias; atrial fibrillation; NSTEMI

59

O2S2.2| Santa Strazdina - D-dimere level correlation with transesophageal echocardiography finding in patients, with atrial fibrillation before cardioversion Author: Santa Strazdina, Oskars Kalējs, Ginta Kamzola, Sandis Sakne E-mail: santa.strazdina@gmail.com Mentor: Assoc.prof. Kristīne Jubele Rīga Stradiņš University, Pauls Stradiņš Clinical University Hospital, Deparment of Aritmology, Riga, Latvia Introduction Transesophageal echocardiography (TEEHO) is widely used test to evaluate cardiac sources of thromboembolism and is established as a gold standard to exclude left atrial thrombi. D-dimer is a soluble fibrin degradation product and is an established blood test that reflects activation of the coagulation system. D-dimere is well evaluated in patients with deep venous thrombosis. Elevated D-dimere levels have been described in patients with atrial fibrillation, with left atrial thrombus and/or spontaneous echo contrast. However, there is lack of information to use D-dimere in clinical setting as a negative predictive value for left atrial thrombus. Aim The aim of this study is to determine if D- dimere assay could be used as a negative predictive test for intracardiac thrombotic activity. Materials and methods This retrospective observational, single-center study comprised 81 patients with atrial fibrillation or atrial flutter, before cardioversion, who were tested for D-dimere levels and had TEEHO performed.

Results: We analysed 81 patients. Mean patient age was 63.47(10.66) from which 35.8% (n=29) were women. Patients who had negative TEEHO finding for thrombus or echo contrast 86.5% (n= 45) had D-

60

dimeres below 0.5 mg/LFEU, but above 0.5 mg/L FEU 13.5% (n=7). 40%(n=4). In intense echo contrast group, above D-dimere cut-off value was 60% (n=6) of patients, but below D-dimere cut-off value was 40% (n=4) (p=0.01). Conclusion This study shows that, there is a statistically significant correlation between D-dimere test results and TEEHO findings of intracardial thrombus. However, patients with intense spontaneous echo contrast, and D-dimere, below 0.5 mg/FEU comprised 40% of intense echo contrast group.This finding indicates, that in this patient group, thrombotic process in left atrium cannot be excluded. Keywords: D-dimere; atrial fibrillation; echo contrast

61

O2S2.3| Vanja Dragašević – Newborn screening of phenylketonuria in Vojvodina Author: Vanja Dragašević E-mail: dragasevicvanja@gmail.com Mentor: Assoc. Prof. Ivana Kavečan Faculty of Medicine Novi Sad, University of Novi Sad, Pediatric Department Department of Medical Genetics of the Institute of Children and Youth Health Care of Vojvodina Introduction Phenylketonuria is an inborn disorder of metabolism, a rare, hereditary disease caused by deficiency of phenylalanine hydroxylase enzyme necessary for conversion of phenylalanine into tyrosine. In untreated patients, the concentration of phenylalanine in the organism will increase, leading to harmful toxic effects. Aim The aim of this study is to determine the incidence of hyperphenylalaninemia and classical phenylketonuria in population of the Autonomous Province of Vojvodina. Material and methods In order to investigate the incidence of hyperphenylalaninemia, data from the Republic Institute for Statistics and the Institute for Public Health of Vojvodina were used. Medical documentation of the Department of Medical Genetics of the Institute for Health Protection of Children and Youth of Vojvodina was used. Biochemical analyzes were done using Guthrie's test and a fluorescent nynindrin method. Descriptive and analytical statistical methods were used to analyze the obtained results.

62

Results The incidence of hyperphenylalaninemia in the Autonomous Province of Vojvodina was 1: 9.473. The majority of patients (51%) had classical phenylketonuria, which was detected during the fifteen year period in 15 newborns. The incidence of classical phenylketonuria was 1: 18.315. Conclusion Autonomous Province of Vojvodina belongs to the group with the medium incidence of hyperphenylalaninemia in the world. Determining the form of the disease is necessary in order to plan the urgent diet of the child, which improves the quality of life of persons who have suffered as well as whole families. Keywords: phenylketonuria; phenylalanine; neonatal screening; early diagnosis; newborn

63

O2S2.4| Mona Kostić – Risk factors of the first febrile seizures

Author: Mona Kostić E-mail: tatjana.redzek@gmail.com Mentor: Assoc.Prof. Tatjana Redžek Mudrinić Faculty of Medicine, University of Novi Sad, 21000 Novi Sad Introduction Febrile seizures, as the most common neurological disorder in children from 6 months to 6 years of age in absence of intracranial infection, are associated with fever, equal to or higher than 38°C; pathogenesis of febrile convulsions has not yet been explaned; it is suggested that the a combination of genetic factors, fever and brain maturation has a main role. Aim Objective is to determine which of the risk factors ( fever and positive family history ) is more common in children with febrile seizure; to determine whether these two risk factors are more frequently present together or separately Material and methods The research was conducted in the form of a two-year retrospective study; the study group included 199 patients, the medical records of patients who were hospitalized after the first febrile seizures was examined; the methods of parametric statistics were applied. Results Positive family history was present in 91 patients (46%) and body temperature was equal to or higher than 38°C in 166 patients (83%); 44 patients (22%) had both risk factors for febrile seizures; The average body temperature at the time of febrile seizure was 38.7°C.

64

Conclusion The first hypothesis is confirmed, that fever (> 38°C) is the main risk factor of febrile seizures; the second hypothesis is not confirmed, since children often have only one risk factor rather than both. Keywords: febrile seizures; fever; positive family history

65

O2S2.5| Stefan Spasić – Experiences of Neurology clinic of Military Medical Academy with Fingolimod in Multiple Sclerosis T Author: Spasić Stefan, Tijana Stankojković E-mail: stefankm94@gmail.com Mentor: Prof. Evica Dinčić Military Medical Academy, University of Defence, Belgrade, Serbia Introduction Multiple sclerosis is a chronic, neurodegenerative, autoimmune disease of the central nervous system, characterized by inflammation, demyelination and axon degeneration. Fingolimod is a drug of the second line of immunomodulatory drugs, which effects its effect by modulating sphingosine 1-phosphate receptors, found on lymphocytes, endothelial cells, central nervous system cells, and myocytes at the antrum. Aim To determine the efficacy and possible side effects of fingolimod, used in the treatment of highly active and rapidly progressive relapsing-remitent forms of multiple sclerosis despite therapy with interferon-beta. Material and methods We had 6 patients, the sex ratio M: F is 2: 1, the average age is 38 years. All were on the previous therapy of interferon-beta, but due to an inappropriate response, they were transferred to fingolimod. Patients on average had a diagnosis of 9 years, and on this drug on average 3 years and 5 months.

66

Results Out of the initial 6 patients, 4 are currently on therapy. One patient, female, was excluded because of a poor spirometry finding, while two male patients had a large number of nevi, after PH findings one of them was disconnected from the therapy. Other patients are well tolerated and happy with its effects. All patients are without new lesions on magnetic resonance. Conclusion Fingolimod is a medicine recommended for comfortable use (1 tablet per day), a high degree of efficiency and good tolerability. But the introduction of this medicine requires caution and monitoring of the possible occurrence of lymphadenopathy, inecision, cardiovascular and dermatological complications, edema of the macula and teratogenic effect. Keywords: multiple sclerosis; fingolimod; undesirable effect

67

O2S2.6| Bojan Tepić – Atrial fibrillation as a predictive factor on ischemic stroke outcome

Author: Bojan Tepić, Miljan Tešić

E-mail: bojantepic996@gmail.com

Mentor: Prof. Duško Račić

University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina

Introduction

Stroke is the second cause of death and the leading cause of disability worldwide. One in every six strokes occurs in patients with atrial fibrillation. Atrial fibrillation is a common arrhythmia that is associated with a high risk of stroke, particularly cardioembolic stroke. AF carries an annual risk of thromboembolic complications of three to six percent which is five to seven times greater than that of controls with sinus rhythm. When transitory ischemic attacks and clinically hidden, “silent”, strokes are also taken into account the rate of cerebral ischemia which follows non-valve atrial fibrillation exceeds seven percent per year.

Aim

The aims of this research were to determine the connection between atrial fibrillation and stroke, the connection of atrial fibrillation after the stroke event with neurological and functional status, and to determine the effect of atrial fibrillation after stroke on the outcome of the disease.

Material and methods

This research was conducted as a retrospective study in the period of the year of 2018 at the Clinic of Neurology, University Clinical Centre of the Republic of Srpska. and it included 305 stroke patients.

68

Results

Of the total number of patients, 34,84% had atrial fibrillation as a risk factor for stroke. In patients with stroke and atrial fibrillation, the total mortality was 43,04% which is, in statistic term significantly greater than the total mortality which was 26,52%. By analysing NIHSS, we noticed that patients with atrial fibrillation had more difficult deficiency on Admission in comparison with patients without atrial fibrillation (NIHSS 13,8 on admission compared with 8,4) and that it remained its deficiency even after patient’s release ( NIHSS was 7,8 on release compared with 4,9). Also, when we, on admission, analysed Rankin score, we found that patients with atrial fibrillation had more difficult functional deficiency on Admission in comparison with patients without atrial fibrillation (Rankin score was 4,4 on admission compared with 3,8), and that deficiency remained on release too ( Rankin score was 4,3 on release compared with 3,2).

Conclusion

In conclusion, it should be emphasised that atrial fibrillation is a significant risk factor for stroke and that patients with atrial fibrillation have worse prognosis after stroke event as well as worse functional recovery of patients.

Keywords: stroke; atrial fibrillation; incidence; prognosis; NIHSS; Rankin score

69

O2S2.7| Mervana Halilović – The incidence of cervical cancer in Una-Sana Canton Authors: Mervana Halilović1, Rijad Halilović2, Fatima Gondžo1, Jasmina Hakmi1

Mentor: mr.sci.dr med.Mirsad Halilović3

E-mail: mervanah@gmail.com 1 Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina 2 Faculty of Medicine, Sarajevo School of Science and Technology (SSST), Bosnia and Herzegovina 3 JUDZ Ključ, Department of Gynecology, Bosnia and Herzegovina Introduction Cervical cancer is a malignant disease that affects women. It is caused by uncontrolled growth of cells that build the cervix. The biggest known risk factor for the disease is HPV(Human Papillomavirus). Disease can be prevented in 80% of cases by preventive examination and Pap test. Prevention of HPV infection is also the prevention of cervical cancer. Today, there are two groups of HPV vaccines: prophylactic (preventive) and therapeutic HPV vaccines. Cervical cancer occupies the second place, by the frequency of reporting and by mortality, from all gynecological cancers, just after breast cancer. This disease is most common in women aged between 45 and 50. The highest mortality by age groups have women aged above 65 years, which is related to advanced disease at the time of diagnosis. About 500.000 women are affected and about 250.000 women die every year in the world. Cervical cancer is an ideal screening disease, because typically we have a long preclinical phase, which allows early detection. The use of the Pap test (taking cervical smear and staining it by the Papa Nicolaou method) is currently the best available method of reducing morbidity and mortality of invasive cervical cancer. In Europe, about 65.000 women still have cervical cancer and about 32.000 women die annually. Southeast Europe has the highest incidence and mortality rate of cervical cancer, with about 9000 new registrated patients with this disease and 4600 dead women. Our analysis shows that cervical cancer is a serious health problem in our country due to low quality register of these diseases.

70

Aim This paper has three aims. First was to establish the presence of cervical cancer in the Una-Sana Canton. Second was to determine the most common age interval for cervical cancer. The third one was to determine the prevalence of cervical cancer in the Una-Sana Canton by municipalities for a period of 10 years. Materials and methods The study used data from the Public Health Institute of the Una-Sana Canton in Bihac. Data were taken from 8 municipalities of the Una-Sana Canton. Based on data we have identified patients by age groups. Seven age groups were considered. The number of reported cases of malignant neoplasm in the used data covers the period from 2006 to 2016. Descriptive statistical data processing was performed. As a material in this scientific research we used cervical swabs and samples taken by biopsy. The methods we came up with for statistics included the results of the Papa test and tumor markers. Results The age interval from age 45 to 54 represents the period of the most frequent incidence of malignant neoplasm of the cervix in patients in the area of Una-Sana Canton. The results show the tendency of an increase in the number of patients suffering from illness in Bihac, although the number of gynecologic clinics has increased. We are justifying the low number of registered patients with cervical cancer by possible changing of the gynecological service and by reducing the number of annual examinations. Our data indicate that there is no good record of the presence of cervical carcinoma in the area of the Una-Sana Canton, which should be paid special attention to, because we have large oscillations in the number of recorded cervical neoplasms by the years for which we had data. The number of inhabitants for the four municipalities (Bihac, Cazin, Bosanska Krupa and Velika Kladusa) is just over 200.000. Taking this into account and by comparing the number of registered patients with malignant neoplasm with real cases from practice, we come to devastating results.8 In the period of 10 years (from 2006 to 2016), only 0.11% of patients in these four municipalities of the Una-Sana Canton were registered.

71

Conclusion No municipality at the area of the Una-Sana Canton has a quality register of these diseases. These results indicate the urgent need to establish a quality registry for the prevention and treatment of malignant neoplasms. By analyzing the data we come to the conclusion that the age interval from 45 to 54 represents the period of the most frequent incidence of cervical cancer in patients in the area of the Una-Sana Canton. The presence of cervical cancer in the Una-Sana Canton is the highest in the municipality of Bihac, which is also the municipality with one of the best gynecological care. The prevalence of cervical cancer in the Una-Sana Canton over a period of 10 years indicates the highest total number of patients in the municipalities of Bihac, Cazin and Velika Kladusa. Keywords: cervical cancer; Human Papillomavirus (HPV); Pap test; HPV vaccines

72

O2S2.8| Neda Šapić – Importance of risk factors for the occurrence and maintenance of chronic leg ulcers Author: Neda Šapić E-mail: nedasapic@gmail.com Mentor: Assist. Prof. Ana Ravić Nikolić Clinic of dermatovenereology, Clinical center Kragujevac, Faculty of medical sciences, University of Kragujevac Introduction Discovering the risk factors is substantial in suppressing prevalence of chronic leg ulcers. Some of them can be modified - variable risk factors, some of them cannot - unvariable risk factors. Variables are: obesity, smoking, hypertension, anemia, thrombocytopenia, bacterial infections, cholesterol level, glycemic, acute phase proteins, profession, marital status. Unvariables are gender, age, genetic diseases. The most important are variable factors, because they can be changed by changing of lifestyle, which can prevent disease. Aim The aim of study was to determine correlation of risk factors with occurrence and maintenance of chronic leg ulcers. By defining risk factors, preventive measures can be implemented and the disease and complications prevented. Material and methods Retrospective study included 77 patients over the age of 18, who were hospitalized and treated at the Clinic of dermatovenerology in Kragujevac, from 2015. to 2017. Monitored parameters are gender, age ,profession, marital status, smoking, hypertensia, anemia, thrombocytopenia, bacterial infections, acute phase proteins such as CRP and fibrinogen, albumins, glycemic, cholesterol, neurological, endocrinological and vascular diseases. Parameters are taken from laboratory analysis and medical documentatioн, approved by Ethics Committee.

73

Results Among patients majority were women (0.62). Most of the patients were retired (0.66), born in 1949., married (0.80), nonsmokers (0.83), with hypertension (0.81.). Mean values of erythrocytes, hemoglobin, platelets, fibrinogen, albumins, glycemic and cholesterol are within referent values,while CRP values are raised (16,7). Neurological (0.3), endocrinological (0.16), cardiovascular desiases (0.94) and bacterial infections (0.70) are present. Conclusion The study had shown that risk factors that correlate with occurrence and mainrenance of chronic leg ulcers are female gender, older life, marital status, raised values of arterial tension and CRP, associated neurological, endocrinological and cardiovascular diseases and bacterial infections. Remaining parameters are within referent values so connection wasn`t detected. These conclusion coincides with epidemiological studies by other authors in the world. Keywords: risk factors; leg ulcer

74

O2S2.9| Jelena Obradović – Pyoderma gangrenosum as a sign of internal disease: report of 44 patients Authors: Jelena Obradovic, Tatjana Radevic, Ivana Ilijin, Lidija Kandolf Sekulovic, Zeljko Mijuskovic E-mail: jelena.d.obradovic@gmail.com Mentor: Prof. Zeljko Mijuskovic Department of Dermatology and Venereology, Faculty of Medicine, Military Medical Academy, University of Defence, Belgrade, Serbia Introduction Pyoderma gangrenosum (PG) is rare, destructive, idiopathic disease of unknown etiology which belongs to the spectrum of neutrophilic disorders. It is associated with systemic disease in up to 50% of patients. Aim Determination of diseases associated with PG and their treatment. Materials and methods Hospital database was searched for medical records of patients diagnosed with PG in our institution from 1995-2017. Diagnosis of PG was confirmed according to clinical features, histopathology and appropriate tests for excluding other specific dermatoses. Demographic data, clinical manifestation of the disease, associated diseases and given treatment were recorded and analysed. Results There were 44 patiens, 19 (43.18%) males and 25 (56.82%) females. Average age at the presentation was 45.6 years (range 20-73). The most common location was lower leg in 36/44 (81.82%) patients. Ulcerative variant was found in 30/44 (68.18%) patients, bullous in 3/44 (6.82%) patients, pustular in 10/44 (22.73%) patients and vegetative form in 1/44

75

(2.27%) patient. 21/44 (47.73%) patients had idiopathic disease, in 12/44 (27.27%) an association with inflammatory bowel disease was found. Haematological disorders occurred in 5/44 (11.36%) patients and rheumatoid arthritis in 4/44 (9.09%). The treatment was started with systemic corticosteroids in 36/44 (81.82%) patients, pulse doses were used in 6/44 (13.64%) patients. Most frequently used steroid-sparing agent was dapson in 18/44 (40.91%) patients. Of other steroid-sparing immunomodulatory agent cyclosporine A was used in 8/44 (18.18%), azathioprine in 3/44 (6.82%) and cyclophosphamide in 3/44 (6.82%) patients. Conclusion PG is characterized by sterile neutrophilic infiltration of the skin. The majority of patients has associated systemic disease but can occur also as idiopathic form. The mainstays of management are systemic corticosteroids and immunosuppressive agents with topical corticosteroids as a adjunct to the systemic treatment, and in recent decade infliximab for IBD associated disease must be regarded as the first line treatment. Keywords: Pyoderma gangrenosum; inflammatory bowel disease; corticosteroids; dapson

76

O2S2.10| Nikola Miljković – Evaluation of life quality of students with acnes in relation to smoking status using DLQI questionnaire Author : Nikola Miljkovic E-mail: nikola94km@gmail.com Mentor: Assist Prof. dr. Sladjana Savic Histology and embryology institute, Medical Faculty of University in Pristina, in Kosovska Mitrovica Introduction Acne as the most common dermatosis present on adolescents and youth, has a major impact on quality of their lives and connectivity of smoking and acne is a subject of a numerous researchs Aim The aim of our research is using DLQI questionnaire to assess life quality of students with acnes relative to smoker status. Material and methods Medical students with acnes are asked to complete the Serbian version of questionnaire: Dermatological Life Quality index (DLQI) and provide the answer to the question about smoker status. Participation in the survey was anonymous and voluntarily. According to clinical examination we concluded the absence of the most serious acne types. DLQI questionnaire contains 10 questions, each question has 4 possible answers that are evaluated with a score from 0 to 3 and possible maximum of score is 30. Based on overall score, the effect of decease on life quality is divided in five categories: no influence, small influence, moderate influence, very big influence, and extreme influence on life quality. For analysis of primary data we used descriptive statistic methods and methods for testing statistical hypothesis.

77

Results Total number of students with acnes in our research was 93 and average age of examinees was 19, 20±0,79 years. 31/93 (33,3%) of all examinees with acnes where smokers and 62/93 (66,7%) of them were not. Analysing responses to individual questions in DLQI questionnaire, among the examined groups (smokers or non smokers) was not confirmed the existance of statisticly significant difference. By comparing the total value of DLQI score in relation to smoking status there was not found the existence of statisticly significant difference among examined groups (U=886; p=0,536). Total DLQI score value among smokers was 4,10±4,54 and among non smokers 2,78±2,53, that both of the examined groups classify into the group of patients with low influence of decease on life quality. Conclusion In our research within the both groups of examinees with acnes there is confirmed a low influence of decease on life quality, regardless of whether they are smokers or not. Keywords: questionnaire; life quality; students; smoking

78

O2S2.11| Mirjana Janićijević – Injures of the neck and head of pedestrians in traffic acidents with fatal outcomes

Author: Mirjana Janićijević E-mail: misel94@hotmail.com Mentor: Аssoc.Prof. Miroslav Milošević Faculty of Medicine, University of Priština Title: In pedestrians killed in road accidents, the most common brain injury is destruction, while fractures are the most common on the left side: observational studies Introduction The most significant causes of death in the pedestrian are head injuries. One of the characteristics of car crash is the disproportion of the external and internal findings. With this work, we have tried to determine what are the head injuries that directly lead to the fatal perishing of the pedestrians. The Aim Determination of pathomorphological images of trauma of the head and contents of the labin cavity, determination of the mechanism of injuries of the brainstem and spinal cord, and testing of the hypothesis of disproportion of the external and internal findings. Methods and materials The research was conducted on the material of the Institute for Forensic Medicine "Milovan Milovanović ‘’ in Belgrade.The units of observation were pedestrians who killed in car accidents. The data are taken from post-mortem findings, police reports, medical and other documentation. A total of 66 cases of pedestrian collision from the age of 14 to 87 years were processed. All pedestrians were more than 150 cm tall and at the moment of the collision they were in a standing position and upright position.

79

Results With this study we have found that the third group of external head injuries is the most common brain injury, disruption. Then, the left-hand side vehicle collision is statistically significant p<(0.05) and associated with the fracture of the skull on the left. Among injured who had brainstem injuries, a third of them had the injury of upper cervical spine. Conclusion The highest incidence of brain disruption and cranial cavity content exists in group III of external head injuries; the center of the skull fracture on the left is most common in cases of left-sided collision on the pedestrians; the highest incidence of brainstem injury is in the group of subjects with upper cervical spine injuries (atlanto occipital separation). Keywords: head and neck injuries; pedestrians; traffic accident

80

O2S2.12| Tekula Tejashwini – Seasonal and chronobiological variation phenomenon associated with cardiovascular events occurrence - a retrospective study Author: Tekula Tejashwini, Varahabhatla Vamsi, Itham Venkata Ratnam, Auti Rakesh E-mail: tejashwini.tekula@gmail.com Mentor: Prof. Sergiy Yakovich Dotsenko Department of Internal diseases-3, Zaporozhye State Medical University, Ukraine 2nd International Faculty, Zaporozhye State Medical University, Ukraine Introduction Acute cardiovascular events (ACVD) have seasonal fluctuations, which are to some extent associated with the influence of atmospheric factors. It is the study of seasonal fluctuations in the incidence of most scientific publications. Whereas the role of other climatic facts, such as meteorological (MF) and geophysical (GF) factors, have not been studied enough. Aim To study the influence of seasonal, MF and GF on the frequency of ACVD occurrence. Methods and materials A retrospective analysis of 11285 ambulatory cards of patients visiting Emergency Department, Zaporozhye Regional hospital in the period between January 1, 2014 and December 31, 2017. Analysis of seasonal variations with ACVD frequency was estimated by months and seasons. The assessment of the MF was carried out according to the types of weather: favorable types І and ІІ (with a fluctuation of atmospheric pressure not more than 2-3 mm Hg., temperature and humidity of air within seasonal and daily norms, wind speed up to 4-9 m / s ., and a possibility

81

of thunderstorms, short rain, in winter - snow); Adverse III and IV types (the active cyclones, the change in air temperature 10-20°C and more, for 6-12 hours, fluctuations of atmospheric pressure was from 3-20 mmHg for three hours, the wind speed was 10-16 m / s. We identified the V and VІ types of weather, in which magnetic storms joined the unfavorable III and IV types or the last combination. Statistical processing of the results was made using Statistika 6.0 and P <0.05 was considered. Results The acrophase of the frequency of ACVD occurred in the winter months, there was 10.2 to 10.9% increase in incidence of Acute myocardial infarction (AMI) and unstable angina (US), hypertensive crises - from 9.2 to 10.2%, thrombo-embolism of arteries and veins (TE) - within 10.2 - 12.1% in the analysed period. The MF and GF were most significant in the autumn months, stroke and transient ischemic attack, AMI and US, and TE were increased by 3.68, 2.13 and 2.87 times, respectively. Conclusions Timely analysis of MF, GF along with non-invasive central blood pressure measurement guide with preventive pharmacotherapy of cardiovascular diseases. Keywords: climate; seasons; mortality; blood pressure; acute cardiovascular diseases

82

SCIENTIFIC JURY OF SESSIONS

We thank our professors for their great help and guidance during scientific sessions.

prof. dr Lana Nežić

prof. dr Nela Rašeta – Simović

prof. dr Vlastimir Vlatković

prof. dr Zlatan Stojanović

doc.dr Aleksandra Dominović – Kovačević

doc. dr Bojana Carić Radošević

doc. dr Bojan Stanetić

doc. dr Dragan Hrnčić

doc. dr Igor Sladojević

doc. dr Maja Travar

doc. dr Žarko Gagić

83

WORKSHOPS LEADERS

We are very grateful to all the doctors of University Clinical Center of the Republic of Srpska who accepted to be a part of workshops and teach our students valuable lessons, as well as the menagment of UKCRS who made all of this possible.

Ultrasound guided needle biopsy dr Dijana Mikić

Abdominal ultrasound dr Siniša Vujmilović

Basics of surgery dr Nikola Bojić

dr Đorđe Đumić

dr Haris Vehabović

dr Stanko Pantić

CPR workshop dr Renata Hadžić

Radiotherapy dr Goran Marošević

Spirometry dr Darko Depčinski

ECG analysis dr Jelena Jovanić

dr Miron Marjanović

Clinical genetics dr Nina Marić

Angiography, stenting dr Bojan Stanetić

dr Saša Lončar

Ultrasound of blood vessels of the neck dr Zoran Vujković

Interpretation of ultrasound scans of the thyroid gland dr Dragi Stanimirović

84

OUR PARTNERS

ICMS - International Congress of Medical Sciences, Sofia, Bulgaria

International Medical Students Congress Sarajevo, Sarajevo, Bosnia and Herzegovina

IMSCB - The International Medical Students Congress of Bucharest, Romania

ZIMS - Zagreb International Medical Summit, Zagreb,Croatia

85

NEURI - Student Congress of Neuroscience, Rijeka, Croatia

MDSC - Medical Scientific Conference for Students and Young Doctors, Pleven, Bulgaria

MEDICS - Medical International Conference for Students, Bucharest, Romania

ESCBM - European Scientific Center Biomarkers, Prague, The Czech Republic

86

MEDIZZY - Medical Community

CROSS - Croatian Student Summit, Zagreb, Croatia

BIMCO - Bukovinian International Medical Congress, Chernivtsi, Ukraine

ICHAMS - International Conference for Healthcare and Medical Students, Dublin, Ireland

87

See you next year!

88

For more information, visit our webiste:

www.blimc.org

CIP - Каталогизација у публикацији Народна и универзитетска библиотека Републике Српске, Бања Лука 61(048.3) BANJA Luka International Medical Congress (1 ; 2019 ; Banja Luka) Book of abstracts BLIMC / First Banja Luka International Medical Congress, 16th-19th May, 2019 ; [editors Milica Malešević, Igor Lepir, Živko Ćetojević]. - Banja Luka : Faculty of Medicine, 2019 (Laktaši : Grafomark). - 88 str. ; 21 cm Tiraž 150. ISBN 978-99976-26-31-8 COBISS.RS-ID 8131352

89