On the Occasion of 70th Anniversary of Life and 45 Years of Academic Work of Academician Izet Masic.

In the hilly Balkans, a folk proverb has been circulating for a long time, "It is most difficult to be a prophet in one's own village", which reflects the age-old mistrust of the population towards new ideas. This is not surprising in the least, because since the written history of the peoples of the Balkans has existed, a continuous series of conquerors and local rulers who subjugated the common folks and imposed their world view can be traced. Nevertheless, from time to time, people with great strength appear who not only break the shackles imposed by the powerful, but through their actions find a way to the souls of their compatriots and gain their unreserved trust. One of such spontaneous creators is professor Izet Masic, who achieved a miracle of medical publishing in his Sarajevo and Bosnia and Herzegovina and traced the path of medical science. There may be thousands of medical journals in the world, more or less reputable, and researchers from the Balkans can publish their work in them, but only domestic medical journals can initiate and direct domestic medical research, and educate young researchers in the right way. Professor Masic made it possible for authors from Bosnia and Herzegovina and other Balkan countries to present their results to the world and receive an incentive from impartial experts to continue their work and progress more and more by editing and publishing three domestic journals at once, which are visible in the most important world bases,. The progress in research then translated into improving medical practice and health care of the population. The following details from Professor Masic's biography tell us how this miracle happened. This year, academician Izet Masic, Editor-in-Chief of a few biomedical journals, including Acta Informatica Medica journal, celebrates his 70th birthday and also 45 years of his academic and scientific work.

Operation of Medical Journal Citation Databases Without Control. Dilemma: Are They What They Want to Be in the Eyes of Scientific Community.

The decision of the citation database to include or not include a journal is not subject to the control of another entity, or the professional public, and there are no internationally established ethical standards that the citation database would have to apply. As a consequence of the absence of control, the already mentioned offensive reviews and arbitrary interpretation of the criteria for journal inclusion appear. Given that a journal's entry into the citation database is a condition for its long-term survival, people who make decisions in the citation databases gain the power to shut down or revive certain journals based on personal preferences. Any power that is not controlled is eventually abused. Therefore, our proposal is to urgently establish the principles of ethical behavior of citation databases at the global level and find ways to ensure compliance with such principles.

Predatory Open Access Journals are Indexed in Reputable Databases: a Revisiting Issue or an Unsolved Problem.

INTRODUCTION: Pseudo journals, hijacked journals, fraudulent journals, fake journals, and predatory journals waste valuable research when authors publish their studies in them. AIM: This article described novel suggested features for the identification of fraudulent journals and aimed to explain this issue to help inexperienced scientists avoid publishing in predatory journals. METHODS: The articles related to this topic in were retrieved from PubMed and trustable Internet sources. RESULTS: Unfortunately, some fake journals have made their way into reputable databases, such as PubMed, PubMed Central, MEDLINE, SCOPUS, and Web of Science; thus, the serious question has been raised regarding how we should address this problematic phenomenon. We recommended 28 suggested characteristics of predatory journals for readers to take into consideration. CONCLUSION: Unaware of the detrimental effects associated with publishing in disreputable journals, inexperienced researchers can fall victim to them. Together, as both readers and writers, we should completely boycott predatory journals.

Guidelines for Editing Biomedical Journals: Recommended by Academy of Medical Sciences of Bosnia and Herzegovina.

BACKGROUND: Enormous number of medical journals published around the globe requires standardization of editing practice. OBJECTIVE: The aim of this article was to enlist main principles of editing biomedical scientific journals adopted at annual meeting of Academy of Medical Sciences of Bosnia & Herzegovina (AMSB&H). METHODS: The evidence for writing this Guideline was systematically searched for during September 2020 in the PUBMED and GOOGLE SCHOLAR databases. The inclusion criteria were: original studies, systematic reviews, invited expert opinions, guidelines and editorials. The exclusion criteria were narrative reviews and uninvited opinion articles. The retrieved evidence was analyzed by members of the AMSB&H, then discussed at 2020 annual meeting of the AMSB&H and adopted by nominal group technique. RESULTS: In total 14 recommendations were made, based on A to C class of evidence. The editors should educate potential authors and instruct them how to structure their manuscript, how to write every segment of the manuscript, and take care about correct use of statistical tests. Plagiarism detection softwares should be used regularly, and statistical and technical editing should be rigorous and thorough. International standards of reporting specific types of studies should be followed, and principles of ethical and responsible behavior of editors, reviewers and authors should be published on the journal's web site. The editors should insist on registration of clinical studies before submission, and check whether non-essential personal information is removed from the articles; when essential personal information has to be included, an article should not be published without signed informed consent by the patient to whom these information relate. CONCLUSIONS: Principles of editing biomedical scientific journals recommended in this guideline should serve as one of the means of improving medical journals' quality.

Balkan Clinical Research Registry: Established by Academy of Medical Sciences of Bosnia and Herzegovina.

BACKGROUND: From 2013 the World Medical Association's Declaration of Helsinki explicitly requires pre-registration of a study involving human subjects. The registration gives a chance for improvement of design and avoidance of bias. OBJECTIVE: The aim of this article was to describe process of bearing decision to create regional registry of clinical studies for Balkan countries. METHODS: After finding relevant studies about research registries and designing the concept and structure of future regional registry an article was published in IJBH journal. The article was than used as basis for discussion at 2020 meeting of Academy of Medical Sciences of Bosnia and Herzegovina (AMSBH), and final decision was made by the Academy to create the research registry. RESULTS: Regional registry of clinical studies will be under the auspices of AMSBH and web-based, with the option of online registration of new studies. The data required to be entered in the moment of registration relate to key elements of research plan: topic, variables, sample, type of the study and the study population. After applying for registration of a clinical study, the authors will soon receive the review made by the AMSBH expert committee. The application could be accepted, rejected or returned for major or minor revision. After an application is accepted, it will be deposited in the searchable database and given the registration number. CONCLUSION: The AMSBH's decision to create the regional registry of clinical studies will satisfy needs of researchers from Balkan countries in the first place, who share cultural and lingual similarities. It will also help with increasing standards of clinical research in the region.

What is Importance of the Journal "Medical Archives"?

Medical Archives is the oldest biomedical journal in Bosnia and Herzegovina, and all important individuals of medical clinical practice have been published in the Medical Archives, and even today, in index and citation databases: Medline, PubMed, PubMed Central, Scopus, open access variants, is the main advertiser of medical sciences in Bosnia and Herzegovina. Medical Archives in the future would like to become a free-of-charge journal, which will publish open access articles, because finally, the financial component should be a deciding factor whether the article will be published or not. The journal opened the door to PhD students, which should also be an incentive for further progress. The main goal of the journal is to continuously raise the quality, with the addition of establishment as a source of quality science.

Preliminary report of hypoglycemic response in obese metabolic syndrome males treated with metformin after weight loss intervention.

We conducted this study to determine the degree of obesity influence on the hypoglycemic response of growth hormone and cortisol after weight loss of 5%. A total of 45 non-diabetic, male subjects followed in the outpatient endocrinological departments were divided into three groups comprising 15 subjects in each group, based upon body mass index (BMI) to healthy, overweight and obese group. Metformin was administered in the dose of 50 mg daily to the overweight and obese participants. Cortisol was measured at 0, 60 and 120 minutes. Growth hormone (GH) was measured at -15, 0, 30, 60, 90 and 120 minutes. Values of cortisol and GH were compared upon changes in hypothalamo-pituitary-adrenal (HPA) response to insulin induced hypoglycemia initially and after weight loss of 5% for overweight and obese participants. The BMI of the healthy group ranged 20.0-24.5 kg/m2 (median: 22.8); overweight group ranged 25.9-29.7 kg/m2 (median: 28.3); and obese group ranged 30.9-34.6 kg/m2 (median: 32.6). There were no significant differences of cortisol values among groups at 0 (chi2 = 2.0; p = 0.365); 60 (chi2 = 0.754; P = 0.686) and at 120 minutes (chi2 = 0.466; p = 0.792). The comparisons among groups were significant for differences of GH values at -15 (chi2 = 25.0; p < 0.01); 0 (chi2 = 16.2; p < 0.01); 30 (chi2 = 16.2; p < 0.01); 60 (chi2 = 32.8; p < 0.01); 90 (chi2 = 30.2; p < 0.01) and at 120 minutes (chi2 = 27.3; p < 0.01). Healthy and obese subjects significantly differed in growth hormone response at -15 (Z = 4.67; p < 0.01); 0 (Z = 3.83; p < 0.01); 60 (Z = 2.78; p = 0.05); 90 (Z = 4.67; p < 0.01) and at 120 minutes (Z = 4.23; p < 0.01). Changes on the various levels of HPA axis, when it is activated by a stress as it is the case in insulin-induced hypoglycemia correspond to the degree of obesity. Weight loss of 5% was not enough for restoration of a normal stimulated growth hormone release and did not influence on the level of cortisol.

Gastroesophageal reflux disease and pulmonary function: a potential role of the dead space extension.

BACKGROUND: To evaluate the differences in the existence and size of dead space in patients with and without Gastroesophageal Reflux Disease (GERD and non-GERD) expressed through the size of intrapulmonary shunt (QS/QT). MATERIAL/METHODS: The study enrolled 86 subjects - 43 patients referred for endoscopy because of symptoms of GERD (heartburn, acid regurgitation, dysfagia) and 43 healthy subjects with similar anthropometric characteristics without GERD symptoms. Based on endoscopy findings, patients were classified into the erosive reflux disease (ERD) group and non-erosive reflux disease (NERD) group. Spirometry values, single-breath diffusing capacity of the lung for carbon monoxide (DLCO) and intrapulmonary shunt (venous shunt - QS/QT) determined by the oxygen method were measured in all participants. RESULTS: Statistically significant differences between GERD and non-GERD groups in FVC (p=0.034), FEV1 (p=0.002), FEV1/FVC (p=0.001), and PEF (p=0.001) were observed. There were no statistically significant differences in FEF 25% (p=0.859), FEF 50% (p=0.850), and FEF 75% (p=0.058). Values of DLCO (p=0.006) and DLCO/VA (p=0.001) were significantly lower and QS/QT was significantly higher (p=0.001) in the GERD group than in the non-GERD group. However, in both groups the average values of DLCO and DLCO/VA expressed as a percentage of predictive values were within normal range, while the value of QS/QT in the GERD group showed pathological (6.0%) mean value (normal value ≤ 5.0%). There were no significant differences in respiratory function test results between patients with ERD and NERD. CONCLUSIONS: Our results suggest that microaspiration of stomach contents may cause surfactant damage, development of microatelectasis, and dead space expansion with consequent increase of intrapulmonary (venous) shunt.

The metabolic syndrome is associated with high-normal urinary albumin excretion and retinopathy in normoalbuminuric type 1 diabetic patients.

Although metabolic syndrome was not extensively studied in type 1 diabetes, higher insulin resistance, the core feature of the syndrome was found to be associated with increased risk of developing microvascular complications. As diabetic nephropathy may progress to advanced lesion before microalbuminuria appears, we investigated the association of the metabolic syndrome and estimated glucose disposal rate (eGDR) with urinary albumin excretion (UAE), retinopathy and neuropathy in normoalbuminuric type 1 diabetic patients. Two hundred and 98 patients (UAE < 30 mg / 24 h at three occasions) were divided according to the IDF metabolic syndrome; eGDR (mg kg(-1) min(-1)) was calculated: 24.31-(12.22 x WHR) - (3.29 x HT) - (0.57 x HbA1c), (WHR = waist-to-hip ratio, HT = hypertension). Patients with (n = 99) compared to those without metabolic syndrome (N = 199) showed higher UAE (15.96 +/- 9.10; 13.48 +/- 8.36 mg /24 h), C-reactive protein (2.39 +/- 4.09;1.12 +/- 2.03 mg/L), prevalence of retinopathy (70.7; 55.27%) and polyneuropathy (80.8; 68.3%), and lower eGDR (5.75 +/- 1.74; 8.96 +/- 1.9), (p > 0.05). In patients with high-normal UAE, retinopathy and polyneuropathy eGDR was significantly lower compared with patients with low-normal UAE, and without retinopathy and polyneuropathy. In multiple regression analysis UAE and retinopathy were associated with diabetes duration (beta = -0.20, beta = -0.62), eGDR (beta = - 0.106; beta = -0.041), metabolic syndrome (beta = 0.49, beta = 0.28), (p > 0.05). In type 1 diabetic patients insulin resistance and IDF defined metabolic syndrome are associated with high-normal UAE, retinopathy and polyneuropathy. The predictive value of the metabolic syndrome for development of microalbuminuria and retinopathy needs to be assessed in further follow-up studies.

New paradigm in training of undergraduate clinical skills: the NEPTUNE-CS project at the Split University School of Medicine.

Clinical skills' training is arguably the weakest point in medical schools' curriculum. This study briefly describes how we at the Split University School of Medicine cope with this problem. We consider that, over the last decades, a considerable advancement in teaching methodologies, tools, and assessment of students has been made. However, there are many unresolved issues, most notably: (i) the institutional value system, impeding the motivation of the teaching staff; (ii) lack of a strong mentoring system; (iii) organization, timing, and placement of training in the curriculum; (iv) lack of publications pertinent to training; and (v) unwillingness of patients to participate in student training. To improve the existing training models we suggest increased institutional awareness of obstacles, as well as willingness to develop mechanisms for increasing the motivation of faculty. It is necessary to introduce changes in the structure and timing of training and to complement it with a catalog, practicum, and portfolio of clinical skills. At Split University School of Medicine, we developed a new paradigm aimed to improve the teaching of clinical skills called "Neptune-CSS," which stands for New Paradigm in Training of Undergraduate Clinical Skills in Split.

Predictors of nonalcoholic steatohepatitis in patients with elevated alanine aminotransferase activity.

Incidence of obesity and hepatic steatosis is increasing worldwide. Almost one quarter of western countries population suffer from non alcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the frequency and predictors of nonalcoholic steatohepatitis (NASH) in patients with unexplained alanine aminotransferase activity elevation (ALT), and therefore avoid unnecessary biopsies in cases of simple steatosis. Earlier studies provided different results and have not answered the question how to distinguish NASH from simple steatosis. Ultrasound (US), computed tomography (CT) and magnetic resonance (MRI) can detect steatosis with great sensitivity level, but not NASH. This study included 50 patients (18 women and 32 men) with mean age 43 +/- 9 years, and with defined selected biochemical, anthropometric and hormone biomarkers. The average BMI was 27.1 +/- 3.81 (kg/m2), insulin resistance HOMA IR 3.89 +/-3.81. All patients underwent liver biopsy and NASH was staged by NASH activity score (NAS) from 1 to 8. Results are compared to pathohistological finding as relevant method. The results show that 90% of patients (n=45) had NAFLD (minimal stage at least), and 15 (30%) had nonalcoholic steatohepatitis (NASH). High triglyceride, low HDL and high ferritin serum levels correspond with NASH. As in earlier studies, insulin resistance as basic mechanism of NAFLD and NASH was confirmed.

Interleukins IL-33 and IL-17/IL-17A in patients with ulcerative colitis.

BACKGROUND/AIMS: Disturbance of immune homeostasis in ulcerative colitis (UC) is related to the predominance of T-helper-2 (Th2) immune response. Interleukin (IL)-33 stimulates Th lymphocytes to produce Th2 cytokines, such as IL-4, IL-5, and IL-13, which are believed to induce pathological changes in the intestinal mucosa. The pro-inflammatory role of IL-17 in UC is still unclear. Our aim was to determine serum concentrations of IL-33 and IL-17 in patients with UC and healthy controls. METHODOLOGY: Serum concentrations of IL-33 and IL-17 were measured in 18 patients (10 men) with UC and 16 control subjects (10 men) by using two-layer immunoenzyme procedure (ELISA). RESULTS: Median serum concentrations of IL-33 in patients with UC and controls were 140 pg/ mL (interquartile range [IQR], 72.5 pg/mL) and 165 pg/mL (IQR, 140.0 pg/mL), respectively, but the difference was not statistically significant (Mann-Whitney U=112, p = 0.281). The median serum concentration of IL-17/IL-17A in patients with UC was significantly higher (100 pg/mL, IQR 35.75pg/mL) than that in controls (65 pg/ mL, IQR 32.25 pg/mL) (Mann-Whitney U=55, p = 0.002). CONCLUSION: Serum concentration of IL-33 in patients with UC was not increased in comparison with that in controls, which is in accordance with current evidence that its primary biological effect is transcriptional rather than cytokinal. Further research is needed to explain whether increased concentration of IL-17 in UC is protective or harmful and to elucidate its immunological and pathogenic role.

Cognitive and depressive disorders in multiple sclerosis.

Among other symptoms, multiple sclerosis can also produce symptoms of affective and cognitive disorders. The majority of patients have certain cognitive dysfunctions, and the' most common affective disorder is reactive depression. The aim of the study was to determine the correlation of the Mini-Mental State (MMS) and Beck Depression Inventory (BDI) scale scores with the Expanded Disability Status Scale (EDSS) score in patients with multiple sclerosis treated at University Department of Neurology, Sarajevo University Clinical Center in Sarajevo. We evaluated 50 randomly selected patients with various types of multiple sclerosis using the MMS, BDI and EDSS instruments. The study included 33 women and 17 men (66% : 34%), mean age 40.74 years (SD 9.236). The mean value of EDSS score was 3.98, ranging from 1.0 to 8.5 in women and from 1.0 to 6.5 in men. BDI scale scores showed a mean value of 12.56. The mean MMS score in baseline sample was 26.88. Statistically significant positive correlation was found between age and EDSS score, and negative correlation between EDSS and MMS, as well as between BDI and MMS. Study results indicated older patients with multiple sclerosis to have a higher EDSS score with more pronounced cognitive disturbances. There was no statistically significant correlation between EDSS score and depression.

Successful conservative and endoscopic treatment of pancreatic fistula due to splenectomy following blunt abdominal trauma.

Pancreatic fistula most commonly occur as a consequence of resective procedures and pseudocyst drainage, and rarely as a consequence of splenectomy. Conservative treatment can have good results, but it is long lasting and demands long hospitalization. In case of conservative treatment failure, operative treatment is indicated, but this has significantly higher percentage of morbidity and mortality. In selected cases, conservative treatment with somatostatine or octreotide, along with endoscopic procedure including the use of fibrin glue, significantly accelerates sanation of the fistula and reduces the length of hospitalization. We report a case of exterior pancreatic fistula due to splenectomy following blunt abdominal trauma, which were successfully treated with conservative (infusion, antibiotics, enteral nutrition, and octreotide) and endoscopic therapy. During ERCP papillotomy was performed, and good external drainage using drainage catheter was important in the patient outcome. Considering the initial secretion of 300 mL/24 h, our patient had a high output fistula. Despite that, fistula was quickly resolved after treatment. Our opinion is that octreotide therapy and unobstructed drainage of pancreatic duct into the duodenum were the most important in the rapid resolution of the fistula.

Assessing glycemia in type 1 diabetic patients using a microdialysis system for continuous glucose monitoring.

BACKGROUND: Continuous glucose monitoring systems can monitor moment-to-moment changes in blood glucose concentration, which cannot be detected by intermittent self-monitoring. Continuing monitoring systems may lead to improved glycemic control. We evaluated a microdialysis technique for improving glycemic control in type 1 diabetes patients treated by different means of basal insulin substitution. PATIENTS AND METHODS: Fifty-two type 1 diabetic patients on twice daily NPH and pre-meal aspart insulin were randomized in two groups: the continuation of NPH (n=26) (group 1) or once daily glargine (n=26) (group 2). 48-hour GlucoDay registrations were started at the beginning and after 4 months. RESULTS: At baseline, time spent in the euglycemic range (glucose between 3.9 and 8.0 mmol/L) was 37.96+/-6.81% for the NPH group and 35.83+/-6.24% for the glargine group. At endpoint, time in the euglycemic range increased in both groups (51.02+/-7.22% and 57.29+/-10.27%, P<0.001 vs. before treatment for both groups). Time spent in the hypoglycemic range (glucose <3.9 mmol/L) was 9.+/-2.57% for the first group and 10.24+/-3.55% for the second group at baseline. At endpoint, time in the hypoglycemic range decreased in both groups (8.00+/-2.13% and 6.59+/-2.04%, P<0.001 vs. before treatment for both groups). CONCLUSION: The analysis of the GlucoDay data gave us information about glycemia other than HbA1c and self-monitoring of blood glucose, such us a peakless activity profile and the lower percentage of time spent in the hypoglycemic range in the glargine-treated group.

Dysthanasia: the (il)legitimacy of artificially posponed death.

The concept of "dysthanasia" is still partially known in the world academic community. The concept is opposite to the concept of "euthanasia", incomparably more often mentioned, but without doubt much less often practiced in health-care institutions, especially in intensive care units. The objective of this article is to expound fundamental theoretical and practical aspects of dysthanasia, as well as to encourage discussion about this actual topic. The article discusses the position of dysthanasia within the objectives of contemporary medicine, as well as according to the definition of health by the WHO the definition of illness by the Hastings Center and the Recommendation No. 1418 of the Council of Europe Parliamentary Assembly. It concludes with comments on certain examples of possible dysthanasia from the world history and two actual examples from our clinical practice.

Transcranial Doppler ultrasound assessment of intracranial hemodynamics in patients with type 2 diabetes mellitus.

BACKGROUND: Diabetics have a 3-fold risk for cardiovascular diseases compared with non-diabetics. This study was designed to evaluate cerebral hemodynamic changes related to type 2 diabetes mellitus (DM) with transcranial Doppler ultrasonography (TCD). TCD is a highly sensitive and specific method of quick bedside assessment of cerebrovascular circulation hemodynamics. PATIENTS AND METHODS: In a prospective study, we compared a group of 100 patients with the diagnosis of type 2 diabetes mellitus (aged 48 to 67 years) and an age- and sex-matched control group of 100 healthy subjects without diabetes mellitus. We measured flow velocities (Vm) and the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTS: The rate of TCD abnormalities was significantly higher in diabetic patients than in healthy control subjects (55% vs. 11%, P < 0.05). The PI was significantly higher in diabetic patients than in healthy controls (P < 0.001). Atherosclerotic changes were found in 34.0% and 71.4% of patients suffering from diabetes for <5 and > or =5 years, respectively. CONCLUSION: This study suggests that TCD is a useful marker for the detection of diabetic cerebrovascular changes. The duration and type of diabetes were found to have an impact on the development of pathologic cerebrovascular changes.

Colonic lipoma intussusception: a case report.

Lipomas are the most common mesenchymal benign tumor of the colon. They are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. The diagnosis can be made by colonoscopy, barium enema examination, and by computed tomography (CT). We have reported a case of large submucosal lipoma of the ascending colon with intestinal obstruction. At laparotomy there was an intussusception descending colon, and subtotal colectomy was performed.