Acta Medica Saliniana

Introduction: Inflammatory fibroblast tumor is rare tumor that most often occurs in younger people, usually 30 years old or younger, but most commonly in children age 6-10 years. It usually affects gastrointestinal tract and the lungs but it can also occur in several places at the same time. Clinical manifestations vary depending of the affected system of the body so it is very difficult to determine diagnosis without surgical extirpation and patohistological analysis. Complete surgical resection is curative in most patients and recidivism is rare. Liver abscesses more common occur in females with risk factors and medical history of diabetes, previous liver disease and less likely in patients with granulomatous diseases. Liver abscesses mortality in developing countries is 2-12%, increasing due to open surgical drainage.Case report: We present a 35 years-old patient who was treated at the Clinic for Infectious Diseases University Hospital Mostar and University Hospital Sarajevo, Clinic for Infectious Diseases in August and September 2018 and Clinical Hospital Merkur, Zagreb Surgery Clinic in December 2018. Data was used from medical documentation. Young, immunocompetent patient who was addmited to a hospital following high fever, chills and poor general condition was diagnosed with multiple focal necrotic lesions, differential-diagnostically most likely liver and spleen abscesses with high suspicion of liver malignancy. Liver biopsy was performed and patohistological analysis confirmed the diagnosis of multiple liver abscesses in the IV and VI liver segment, and inflamatory fibroblast tumor in the IV liver segment. Eight weeks of conservative treatment resulted in a complete regression of liver abscesses and inflamatory fibroblast tumor was surgically extirpated at the Clinic Hospital Merkur, Surgery Clinic in the Zagreb in December 2018.Conclusion: An approach to a patient with a multiple liver abscesses and liver tumor requires sub-specialists experience and urgent multidisciplinary diagnostic and treatment approach to prevent further complications and deadly outcome.

Svjetlana Grgić

Linda Soldo Čorić

Vesna Antunović Skelo

Sanja Šanje Kukić

Helien Bebek Ivanković

Željana Sulaver

Belma Gazibera

Inflamatory fibroblast tumor and liver abscesses in the young patient

年轻患者中的炎性纤维母细胞瘤与肝脓肿

Background: The quantification of HBsAg provides different and complementary information that helps in determination of the different phases of chronic hepatitis B viral infection, evaluation and follow-up of liver disease progression as well as in treatment individualization.Aim: To evaluate the clinical significance of quantitative HBsAg (qHBsAg) in patients with HBeAg negative chronic hepatitis (CHB) and its correlation with the serum levels of alanine aminotransferase (ALT), quantitative HBV DNA and liver fibrosis.Subjects and Methods: The study included 53 treatment naïve patients with HBeAg negative chronic hepatitis B. All patients underwent complete laboratory and serology testing, quantification of HBV DNA and HBs antigen. The liver stiffness was measured with elastography. Patients’ demographic characteristics, viral and biochemical markers were recorded at one point of time.Results: Correlation analysis between the qHBsAg and ALT showed an significant, positive correlation between the parameters for R=0.42 and p&lt;0.05; there was statistically non-significant positive correlation for R=0.25 and p&gt;0.05 between qHBsAg and HBV DNA. There was a positive correlation between qHBsAg and liver fibrosis for R=0.08 and p&gt;0.05. The serum levels of HBsAg had greater impact on the serum levels of ALT compared to that of HBV DNA for R=0.15 and p&gt;0.05.Conclusion: Patients with higher ALT values and higher liver fibrosis score have higher qHBsAg; qHBsAg can reflect the serum HBV DNA levels.

Marija Dimzova

Mile Bosilkovski

Magdalena Gasheva

Boban Toshevski

Biljana Petreska

Marija Cvetkova

Dejan Jakimovski

The clinical significance of quantitative HBSAG in patients with HBEAG negative chronic hepatitis B

HBEAG阴性慢性乙型肝炎患者HBSAG定量检测的临床意义

Introduction: Infectious mononucleosis is one of the most common syndromes in our clinical practice. It is characterized by elevated temperature, pharyngitis and generalized lymphadenopathy.Objectives: To describe a clinical charachteristics of infectious mononucleosis (IM) caused by the Epstein Barr virus (EBV) in splenectomized patients since in the literature we found insufficient data.Subjects and Methods: Retrospective analysis of medical documentation of the patient treated in the Clinic for Infectious Diseases of the University Clinical Center of Republic of Srpska.Results: We have described the case of infectious mononucleosis, caused by Epstein Barr virus in a splenectomized patient. In support of acute EBV viral infection were the presence of lymphadenopathy, pharyngitis, hepatomegaly, as well as the occurrence of a typical generalized maculopapulous rash, and positive ELISA EBV VCA IgM and anti EBV VCA / EA IgG, were reported. According to the aforementioned patient, it fulfilled most criteria for setting the diagnosis of acute EBV infectious mononucleosis. Our patient showed some atypical signs such as absence of fever during hospitalization, marked leukocytosis with lymphocytosis (with a maximum increase in leukocyte count at 37.3 x 109, in the differential blood sample dominated lymphocytes with 29.96 x 109 (reference values 1.1-3.35), i.e. 80.3% (Ref. 20.0-46.0). Due to the maintenance of leukocytosis with lymphocytosis, the range of clinical has been extended trials (US abdomen, US neck, CT neck, chest, abdomen and pelvis, sternal puncture, hematologists' consultation). Based on the aforementioned hematologists' consultation, and post-release and recovery monitoring it is concluded that there has been no sign of acute hematologic disease but it has been just EBV-IM.Conclusion: Because of insufficient data on clinical presentation of Epstein Barr viral infections in splenectomized this we believe that this is one of the clinical variants although the possibility of individual variation cannot be excluded. Briefly, we can conclude that the immune system in the splenectomized patient can greatly modify the clinical presentation of Epstein barr viral infection, with the pathogenic mechanism that are still unclear.. However, due to the variety of clinical syndromes and the oncogenic potency of the Epstein-Barr virus, we should be extremely cautious and sometimes expand the diagnostic range beyond conventional examinations.

Ljiljana Pašić

Dragan Kasapović

Milan Petrović

Zdravka Kezić

Antonija Verhaz

Snežana Ritan

Infectious mononucleosis in splenectomised patient

脾切除患者中的传染性单核细胞增多症

Background: Hepatitis C virus (HCV) genotypes and subtypes exhibit significant geographic variations.Aim: To analyse the distribution of genotypes/subtypes of HCV in a group of patients with chronic hepatitis C from Canton Sarajevo during 2012-2018.Material and methods:The study enrolled 247 human plasma samples of HCV-RNA positive patients with available results of HCV genotyping test.Results: During 2012-2018, the domination of subtypes 1a (34.01%), 1b (28.34%) and genotype 3 (23.89%) was registered. In 2012 and 2013, HCV subtype 1a was the most common (27/63; 42.86% and 17/40; 42.50%, respectively). In 2014, the leading HCV genotype/subtype were 3 and 1b (17/57; 29.82%). In 2015, the dominance of HCV genotype 3 (14/39; 35.90%) continued, while in 2016, the same number of HCV subtypes 1a and 1b (11/30; 36.67%) was recorded. Although in a small number of tested, during 2017, HCV subtype 1b was the most prevalent (7/14; 50.00%), and in 2018, it was replaced by a HCV subtype 1a (3/4; 75.00%). Distribution of HCV genotypes/subtypes by age group of patients varied significantly (p=0.000). The largest number of patients (71/247; 28.74%) belonged to the age category 30-39 years and HCV genotypes/subtypes 1, 3, 4, 1a and 1b were identified. Except in 2017, male gender significantly dominated (p=0.000). In males, HCV subtype 1a (68/170; 40.00%) was the most common, while in women it was HCV subtype 1b (44/77; 57.14%).Conclusion: This six-year retrospective study showed the time variations of the circulating HCV genotypes/subtypes among patients with chronic hepatitis C in Canton Sarajevo. Genotyping of the HCV has an important implications for diagnosis and treatment of the patients.

Irma Salimović- Bešić

Adna Kahriman

Suzana Arapčić

Amela Dedeić- Ljubović

Distribution of hepatitis C virus genotypes and subtypes in a group of patients with chronic hepatitis C from Canton Sarajevo, 2012-2018

2012-2018年萨拉热窝市慢性丙型肝炎患者丙型肝炎病毒基因型及亚型的分布

Introduction: Prevention of surgical site infection in surgery and bone trauma has some hallmarks not shared with other surgical disciplines. The surgeon is not always able to open the pathogen and a key to correct therapy. The aim of our work is to verify if there are differences between pathogens, and treatment between the two groups most susceptible to skin infections by means of synthesis such as children and the elderly. Materials and Methods: From January 2011 to december 2018, we perform 3189 consultancies in various departments of orthopedics and traumatology. From the exclusion criteria we recruited 168 patients with superficial infection of the surgical site after orthopedic surgery. A group represented by children (under 12 years old) and a group of older people over 65. The evaluation criteria between the two groups were: the infectious bacterial flora; the type of antibiotic, the duration of antibiotic therapy; the type of medications used in the post-operative period, the complications.Results:The results showed that elderly patients are more likely to be bacterial superinfection due to poor hygiene. Therapy in children is shorter and has minor complications. Proper management of the surgical site showed a rapid resolution of the infection in both groups. Conclusion: The correct management and hygiene of the surgical site allows its rapid recovery from infection. The plastic surgeon management of the fracture site infection can be a winning weapon in the treatment of this problem both in the child and in the elderly.

Raffaele Franzese

Michele Conte

Nicola Gagliardo

Gorizio Pieretti

Children vs elderly in orthopedic surgery site of infection. Are there difference? Experience of a high volume plastic surgeon consultant.

儿童与老年人在骨科手术部位感染中的差异：一位高容量整形外科顾问的经验。

INTRODUCTIONTransfusiontreatmentinmodernclinicalpracticeincludessubstitutiontherapy certaincomponentsoftheblood,whichadequatelyandeffectivelycontributetoquickrecoveryandhealing diseases[1].Almosteverybranchofmedicineistransfusion-dependent,startingwithsurgeryandinternalmedicine branchtodiagnosticones,wherethesafetyofthepatientisensuredbysubstitutionwithcertainblood preparations[2]. Bloodandbloodproductsdifferfromotherdrugsandpharmaceuticalpreparationswhile the only source is humanbloodfromvoluntarydonors[3].Inpractice theyusetwowaysofgettingblood,byvoluntarydonation,whenwholebloodistaken,whichisthemostcommon usedasastartingpointfortheproductionofotherdrugsfromblood,andbytheapheresisprocedureon cellseparator,whenonlyonebloodcomponentistaken,suchasplatelets,plasma, erythrocytes[1,4] Anadequatebloodtransfusionsupplyiscrucialforthefunctioningofthehealthsystem[5].Althoughtheyare bloodanditscomponentsrecentlyaddedtotheWHOessentialdruglist,insufficientbloodsuppliesinmost oflow-andmiddle-incomecountriesstillleadtomortalityandmorbidity,whichcan preventbyensuringsufficientbloodreserves[6,7]. Ensuringsufficientamountsofbloodimpliesstrategicconsiderationoflocal,epidemiological factors,demographicstructure,equipmentandabilitytoproducemedicinesfromwholeblood[8,9]. Currently,voluntaryblooddonationinmanylow-andmiddle-incomecountriesisnot adequately[10].Themainreasonsfortheunavailabilityofbloodisthehighprevalenceofviralhepatitisand inadequateproductionofbloodcomponents[11].Overallrelationsinsociety,socio-economicand demographicsareanimportantfactorforassessingthepossibilitiesofensuringstablereservesofsafeblood,which theyrepresentthenationalresourceofacountry[12].Theestimationofthedailyconsumptionofbloodproductsis unpredictablenature,duetopossibleincidentsituations,naturaldisasters,andlimited lifetimeofdifferentpreparations.Thelimitedlifespanofbloodincreasesthenumberofunuseddoses, resultinginadecreaseinstablereservesandhighcosts[6]. AccordingtoWHOguidelines,recommendationsforensuringstablebloodreservesinclude10to20 donationsper1000inhabitants[13].Theseassessmentsareimportantbecausetheycanservetoguidefurtherones investmentsinstrategiestoensuresufficientamountsofblood,thenanalysisofcurrenttransfusionpractice, introductionofrationalizationmeasuresduringtransfusiontreatmentandimplementationofthesystemfor bloodmanagement[14,15].IntheareaofTuzlaCanton,theannualblooddonationisapprox. 13000doses.Formorethanthreedecades,thePolyclinicforTransfusionhasbeenproducingvariousmedicinesfrom blood,whoselifespanandstoragemethodaredifferent,namely:wholeblood,erythrocyteconcentrate,concentrateerythrocyteswithareducednumberofleukocytes,irradiatederythrocyteconcentrate,freshfrozenplasma, plateletconcentrate,plateletconcentratewithreducednumberofleukocytes,irradiatedconcentrate platelets,plateletapheresisconcentrateandcryoprecipitate. MATERIALANDMETHODSThis retrospective study was carried out at the Polyclinic for Transfusion, University Clinical Center Tuzla data from the Renovatio information system in the period from July 1, 2022 to December 31, 2022. Data were analyzed on voluntary blood donors (age and gender), who donated blood during that period. Then data on the number of blood doses collected, as well as the number and type of medicines produced from blood (whole blood, erythrocyte concentrate, erythrocyte concentrate with reduced number of leukocytes, irradiated concentrate platelets, fresh frozen plasma, cryoprecipitate, platelet concentrate, platelet concentrate with a reduced number of leukocytes, irradiated platelet concentrate, irradiated platelet concentrate with reduced number of leukocytes, as well as platelet concentrate produced by the apheresis method using of the Amicus cell separator. Also, data was collected for patients who received blood preparations: age, gender, diagnosis, type of blood preparation indicated, name of the clinic where the patients were hospitalized, and the type and quantity of blood products issued. RESULTSThelargestnumberofdonatedbloodunitswasusedinthepreparationoffreshfrozenplasma,5742units,then5498unitsofplateletconcentrate,797unitsofcryoprecipitate,and308unitsofconcentrate plateletswithareducednumberofleukocytes,200unitsofirradiatedplateletconcentrateand119units irradiatedplateletconcentratewithareducednumberofleukocytes (Figure 1).

Sunita Delic Custendil

Igor Hudic

Aida Zabic

Sabina Camdzic- Smajic

Almira Cosickic

Lejla Mesalic

Zlatan Mehmedovic

Blood reserves and availability of blood preparations in University Clinical Center Tuzla, Bosni and Herzegovina

波斯尼亚和黑塞哥维那图兹拉大学临床中心的血液储备和血液制品供应情况

Aim: The research aims to explore healthcare workers' attitudes towards and acceptance of artificial intelligence in radiology, focusing on its potential to enhance diagnostic accuracy, reduce waiting times, increase service efficiency, and improve patient care. It seeks to assess their willingness to adopt artificial intelligence, along with their concerns, expectations, and educational needs to effectively utilize this technology in radiological practice.Methods: A prospective study surveyed 50 healthcare workers, including radiologists, technicians, nurses, and others using various radiological techniques for diagnosing diseases. Using a quantitative approach, numerical data from distributed surveys assessed their attitudes and knowledge regarding artificial intelligence in radiology. Conducted at Public Health Institution "Zdravstveni centar Brcko" in Bosnia and Herzegovina's Brcko District over 60 days, the research adhered to ethical principles and received approval from the center's Ethics Committee.Results: The majority of respondents recognize the potential of artificial intelligence to improve the efficiency of radiological services and treatment processes, but at the same time express the need for additional education and training in order to optimally use this technology. Despite the positive perception, part of the respondents are still not sure about the use of artificial intelligence, which emphasizes the importance of continuous information and education of healthcare workers.Conclusion: Ultimately, the research results indicate the importance of further steps in the implementation of artificial intelligence in radiology in order to improve the quality of health care and optimize treatment processes.Keywords: Artificial intelligence, radiological diagnostics, challenges, perspectives, quality of health care.

Benjamin Malkic

Nihad Mesanovic

ANALYSIS OF CHALLENGES AND PERSPECTIVES IN THE ACCEPTANCE OF ARTIFICIAL INTELLIGENCE IN RADIOLOGY BY HEALTHCARE WORKERS

医疗工作者对放射学中人工智能接受度的挑战与展望分析

Introduction: Specific therapeutic methods (STM) are manual techniques used to treat tissue blockade.Aim of this research is to determine efficacy of STM in treatment of lumbar facet syndrome (LFS).Patients and methods. The study included 60 patients suffering from LFS (65% women) aged ~47. The patients were treated ~24 days with the following 2-8 procedures: osteopathy, “myofascial release”, acupuncture, acupressure, “cupping”, neurodynamic, proprioceptive neuromuscular facilitation, kinesiotherapy, “kinesio-type taping”, homeopathy and electrotherapy. All patients were evaluated at admission and discharge through: a. pain scale with visual analogue scale (VAS) marked with numbers 1 to 10 (1 being state of no pain, 10 being state of maximum pain); b. disability with so-called Oswestry index (ODI) expressed in percentages (0-20% being minimum, 80-100% being complete disability); c. quality of sleep, rated through modified Pittsburgh index of sleep quality (PSQI) expressed between 0 (very poor) and 4 (very good). The assessment of improvement in pain intensity and level of disability was conducted via subtraction of values noted before treatment from values at the end of treatment, while the assessment of sleep quality improvement was conducted via subtraction of values noted at the end of treatment from the values noted before treatment. Non-parametric statistical analyses were used. Results: significantly lower values of VAS (p&lt;0.0001) and ODI (p?0.0001), significant increase in PSQI (p?0.0001) at the end in relation to the beginning of treatment, as well as significant correlation between decrease in pain and disability (r=0.3292, p=0.0105). No significant difference in pain (p=0.9856) and disability (p=0.9171 decrease was noticed between sexes.Conclusion: STM is efficient in the treatment of pain attacks in patients of both sexes suffering from LBS.

Rabija Adzemovic

Emir Tupkovic

Elvir Bijedic

Dzenana Damadzic

Omar Suljagic

Specific therapeutic methods in lumbar facet syndrome tratment: prliminary study

腰椎小关节综合征治疗中的特定疗法：初步研究

Background: Screening for colorectal cancer (CRC) can identify premalignant lesions and detect asymptomatic malignant tumors at an early stage that have a better chance of healing, but also longer-term better treatment outcomes. Screening has been shown to reduce mortality from CRC. The aim of this paper is comprehensive education of health care professionals in the Tuzla Canton about this disease, adoption of new guidelines and simpler route from diagnosis to surgical treatment,which ultimately leads to reduced mortality and better outcomes in treatment. Material and methods:The project included family medicine specialists, surgeons and gastroenterologists, 100 of them. The education project was led by two surgeons, who implemented the guidelines ofthe American College of Gastroenterology (ACG) 2021, when it comes to screening CRC. Results: None of the participants offered all correct answers in tests, prior to the training, in both groups of doctors. For a post-educational test, data suggest that there has been a noticeable improvement in the results. In a group of doctors with over 10 years of service, 71 (98.61%) answered correctly all the questions offered and only 1 (1.39%) between 5 and 9 correct answers. For a group of doctors with less than 10 years of service, 26 (92.86%) provided all correct answers and only 2 (7, 14%) between 5 and 9 correct answers.Conclusion: This project pointed to the necessary education of healthcare professionals in this area, who are involved in early detection programmes for CRC, especially family medicine specialists, surgeons and gastroenterologists.

Fuad Pasic

Colorectal cancer screening in Tuzla canton: Project and strategy for patients with average cancer risk

图兹拉州结直肠癌筛查：针对平均癌症风险患者的项目与策略

Objectives: The aim of this study is to investigate the compatibility of pathohistological and Pap findings on material obtained by cervical biopsy and excoalation, and to investigate the compatibility of qualitative histological pattern and diagnosisMaterial and Methods: The study included 152 patients with premalignant lesions of the cervix who underwent Pap testing and targeted cervical biopsy. Archival data on Pap test and histologic diagnosis were collected from available medical records. Information on age and advisable clinical diagnoses was obtained from referrals for pathohistologic examination of tissue. The age of the subjects was determined at the time the tissue samples were collected for analysis. Data on the quality of the material were obtained from microscopic evaluation of the collected materialResults: The largest number of patients was diagnosed with cervical intraepithelial neoplasia type 3 (CIN 3) cytologically (57.2%) and pathohistologically (55.2%). The largest percentage of treated material was rated as very good (46.1%). The majority of respondents (92.4%) had no difference in diagnosis based on Pap test and pathohistological analysis. There was no statistically significant difference in the diagnosis made on the basis of the Pap test and pathohistologic analysis depending on the quality of the materialConclusion: There was a strong positive correlation between the grade established by cytology (Pap test) and the pathohistological diagnosis (PHD). There was no statistically significant difference in the diagnosis made on the basis of the Pap test and pathohistological analysis depending on the quality of the material.M

Valentina Faletar Zivkovic

Ivana Piskur

Iva Milic Vranjes

Jakov MIlic

Vesna Cosic

Jelena Jakab

Milanka Mrcela

Cervical Intraepithelial Neoplasia (CIN) - Comparison of Histological and Pap Results

宫颈上皮内瘤变（CIN）- 组织学与巴氏涂片结果的比较

Publication Information	Publisher: University Clinical Center Tuzla，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2021，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%

Acta Medica Saliniana

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