Varicella-zoster virus (VZV) belongs to the group of alpha herpesviruses, and causes two epidemiologically and clinically distinct diseases, chickenpox or varicella as the primary VZV infection, while shingles respresents the endogenous reactivation of latent VZV infection, typically occuring in older individuls and rarely in younger ones. This is a case report of a 12-year-old boy who was hospitalized at the Clinic for Infectious Diseases at the University Clinical Center Tuzla, diagnosed with meningitis from February 20, 2023, to March 7, 2023. Cerebrospinal fluid analysis upon admission showed moderate pleocytosis with mild proteinorrhoea and hypoglycorrhoea. Cerebrospinal fluid was also subjected to microbiological analysis, which returned a positive PCR result for varicella-zoster virus. Laboratory findings showed stable parameters of inflammation throughout the hospitalization. Parenteral antiviral therapy (acyclovir ampoules) was initiated upon admission and continued for 14 days. Follow-up cerebrospinal fluid analysis showed significant improvement. The boy was discharged home in a recovered state with recommendations for follow-up tests and examinations. Varicella-zoster meningitis is a rare but serious and potentially life-threatening complication following primary infection with the varicella-zoster virus, particularly in immunocompromised patients with symptoms of CNS involvement.

Bacterial conjunctivitis is a common condition in paediatric ophthalmology. Incidence and symptoms depend on etiological factor, clinical presentation and age. The most common pathogens which cause bacterial conjunctivitis are: Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis etc. Conjunctivitis is treated empirically in most cases, the treatment is defined by symptoms and clinical findings, physician prescribes the available antibiotic treatment. Eye swab is indicated in cases of prolonged or non efficient treatment or in case of relapse. Goals: To evaluate bacterial conjunctivitis according to microbial pathogen detected in eye swab, the most common microbial pathogens found and drug susceptibility of antimicrobial agents given in antibiogram. Methods: We retrospectively evaluated 73 microbiological findings of eye swabs in 53 children between January 2019 and March 2020. The sample was cultured on blood and chocolate Gram staining agar incubated under 5-10% CO2, 35-37ËšC with daily reading 40-48h. Bacteria collected from eye swabs were tested for the following antibiotics: chloramphenicol, ciprofloxacin, gentamicin, moxifloxacin, ofloxacin, trimethoprim/sulfamethoxazole, tetracycline, erythromycin, ampicillin, azithromycin, amoxicillin, clindamycin and penicillin. Results: In a total of 53 patients eye swabs were taken, 23(43,39%) male and 30(56,60%) female, age ranged from 0-17 (mean age 32,3±52,3 months or 2,7±4,4 years) most common patient age was 2 years in 40(75,5%) cases. Number of performed eye swabs was 73, and pathogens were isolated in 70(95,9%) cases, and only in 3(4,1%) cases there were no pathogens in eye swab, meaning that indication for eye swab was highly justified. Among isolated pathogens, Staphylococcus aureus was proved to be the most common, in 20(27,4%) cases, the antibiotic with highest drug susceptibility was chloramphenicol in 33(62,3%) cases. Conclusion: Microbiological evaluation of bacterial conjunctivitis is reasonable in moderate to severe cases associated with mucopurulent discharge, prolonged treatment, and as confirmation of diagnosis. Choosing the accurate antibiotic therapy requires identification of pathogen and assessing its susceptibility. Targeted treatment reduces risk of antibiotic overdosing or unnecessary use of antibiotics. Prudent use of antibiotics reduces antimicrobial resistance.Â

Anton's syndrome (AS) describes the condition in which patient deny their blindness despite objective evidence of visual loss, and moreover confabulate to support their stance. It is a rare extension of cortical blindness in which, in addition to the injury to the occipital cortex, other cortical centers are also affected, with patients typically behaving as if they were sighted. This case presents a 76-year-old patient with verified cortical blindness as a result of a stroke. The patient persistently denied vision loss. At the same time, she confabulated to see people and objects in her environment clearly. This syndrome may be unrecognized in routine neurological practice. A suspicion of cortical blindness and AS should be considered in patients with atypical visual loss and evidence of occipital lobe injury. Cerebrovascular disease is the most common cause of AS, as in our patient. Recovery of visual function will depend on the underlying etiology, with cases due to occipital lobe infarction after cerebrovascular events being less likely to result in complete recovery. Management in these circumstances should focus on secondary prevention and rehabilitation.

Introduction: Acute or chronic lumbar pain is very disabling and it negatively affects quality of life. There are several guidelines related to the management of low back pain (LBP), but some studies on the quality of care, provided in the field of general medicine, are judged to be in contrast with them. The objective of this study is to analyze the management of the LBP in the practice of Italian general medicine and compare it with the recommendations of the guidelines. Materials and methods: In this observational study, in a general medical center, 50 patients suffering from chronic LBP were enrolled. All patients, assessed on a case-by-case basis, have been given personalized therapies for their LPB, according to SIOT guidelines in agreement between orthopedic and general practitioner. The monitoring took place over a period of 12 weeks. We evaluated: adherence to therapy; consumption of pain medication daily, second-level diagnostic tests performed post-therapy; The Short Form (12) Health Survey for the evaluation of the quality of life; the VAS for pain and Oswestry Low Back Pain Score for the objective evaluation of the quality of life related to the lumbar spine. Results: In the 35 (70%) patients who adhered to the therapy according to guidelines we had an increase in quality of life, a reduction in pain, a decrease in drug therapy and the performance of II level diagnostic tests compared to 15 ( 30%) who did not adhere to the therapy according to guidelines. However, in both groups an increase in drug consumption was seen 6 months after the evaluation endpoint. Conclusions: The family doctor plays a fundamental role in the management of chronic pain. Patient education plays a key role in therapy and favorable outcomes in patients with LBP.

Introduction: Current international guidelines recommend H1 and H2- antihistamines as a second or third- line drugs for the management of anaphylaxis. Aim: To present positive cardiovascular and dermatological effects of Chloropyramine and Ranitidine as the combination of H1 and H2- antihistamines in additive therapy of anaphylaxis. Patients and methods: In a retrospective study two groups of 146 patients who met the NIAID/FAAN criteria for the diagnosis of anaphylaxis were compared. Experimental group consisted of 62 patients who received combination of Chloropyramine H1- antihistamines and Ranitidine H2- antihistamines. Control group consisted of 84 patients who received only Chloropyramine H1- antihistamines. Results: A statistically significant differences of diastolic pressure and central pulse (p< 0.001), a higher values of diastolic pressure, and a lower values of central pulse in the experimental group of patients were recorded at the end of the prehospital treatment of anaphylaxis. The increase in the mean arterial blood pressure at the end of the treatment is higher in the experimental group compared to the initial values, with an average difference of 15 mmHg (%95 CI= 7,95-21,95). Total prehospital time and time recovery of the skin urticaria and itch was shorter in the experimental group for 18 minutes (95% CI= 11,95-25,95). Conclusion: Positive cardiovascular effects and a faster resolving of the skin symptoms justify the use of combination Chloropyramine and Ranitidine as an additive therapy of anaphylaxis that is not life- threatening, and of a rapid progression.

Background ̸Purpose. Adults as well as children may have problems with strabismus, which can significantly affects on quality of social and professional life. Strabismus surgery in adults are not conditioned for years of a patient, and the main goal of this kind of surgery is to improve motoric-senzorial relationship of eyes, and to improve esthetic moment of a patient. Patients&Methods. A surgical review was performed on 35 adult patients with strabismus in period between January 2016 - May 2018 years. The type of strabismus, preoperative measurements, and indications for surgery were obtained from the patient notes, as were all final outcomes. Final measurements, on average, were 3 to 6 weeks postoperatively, and patients were asked to comment subjectively on their outcome. Results. In total number 35 of adult strabismic patients, were 12 (34,3%) male and 23 (65,7%) female, mean age 34,15±13 ( 20 to 67 years), 17 patiens (48,6%) were exotropic, esotropic 11 (31,4%) patiens, and hypertropic 7 (20%) patients. Indication for surgery in the most cases were aesthetic 28 (80%). The success rate is measured by number of orthophoric patients with less than 10 prism diopters 31 (88,6%), stereoacuity 22 (62,9%) and patient satisfaction 30 (85,7%). Conclusion. Adult strabismus surgery is very successful and provides patients with a good level of satisfaction. Many patients seek surgical correction for cosmetic and psychosocial benefits.Keywords; adult, strabismus, success, surgery

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.

Background: Colonization is the presence of bacteria in the intestines, skin, nose, throat or anywhere in the human body without any signs of infection but with increased risk for spreading bacteria to other patients and the emergence of new infections. Screening of colonized patients is used as part of the prevention and control of multidrug-resistant (MDR) infections caused by agents such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis and multi-resistant Gram-negative bacteria. Material and methods: Data from 169 screened respondents hospitalized at the University Clinical Center Tuzla, between October 1, 2018, and May 1, 2019, were analyzed. Swabs were taken from nostrils, throat, axilla and groin area for all patients, and also from the anorectal area for 157 of them. Identification of MDR bacteria was done by phenotypical methods, according to the recommendations of EUCAST Clinical Breakpoint Table v.8.0, 2018. Results: Out of 169 patients, negative screening test results were found in 93 examinees (55.02%), and positive in 76 (44.97%). The largest number of patients undergoing screening was hospitalized in the Intensive Care Unit (Surgical Block), 73/169 (43.19%). The average screening time was 2.2 days or 53 hours. In 18/76 (23.68%) of patients with positive screening, prior to screening regular microbiological testing was done, and in the remaining 58/76 (76.3%) screening was performed first. Analyzing respondents with positive screening, 27 (35.53%) had negative findings during regular microbiological testing of different biological samples and for 49 (64.47%) different/same strains of MDR bacteria were isolated.Conclusion: Knowing the phenotypic profile of bacteria colonizing patients in intensive care units is a very useful tool in preventing their spread intra- and inter-hospitals.

The treatment of respiratory failure has seen progress since the early nineties. The development of noninvasive ventilation (NIV) provides new possibilities for better treatment and risk reduction. To achieve the therapeutic success of NIV and the reduction in incidence of complications, one must have knowledge of clinical indications and contraindications, the appropriate choice of ventilation modes and ventilation delivery equipment, close monitoring, and ventilation need to be started timely. The development of new technologies has expanded the indications for the use of NIV in children. Of particular importance is the clinical assessment of each patient, a good knowledge of the potential risks for failure of NIV, and creating a written local protocols for the NIV treatment in every health facility where this ventilation technique is applied.

Aim To assess the relationship between the clinical sign of excessive hip abduction (abduction of the hip 90 degrees or more) and developmental dysplasia of the hip (DDH). Methods The research was conducted on 450 newborns in the Neonatal Unit at the Clinic of Gynecology and Obstetrics and the Clinic of Orthopedics and Traumatology of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns hip were performed using the Graf method on their first day of life. Results Clinical sign of excessive hip abduction showed significant predictive value for DDH. There were 37 (8.2%) newborns with the clinical sign of excessive hip abduction, of which 13 of them had DDH while 24 of them did not have this clinical sign. There were 89 newborns, in the overall sample, with one of the forms of DDH, 13 (12.7%) of them had this clinical sign, while from 324 newborns witouth DDH, 24 (6.9%) had this clinical sign. Excessive hip abduction had a positive predictive value (PPV) of 35.1% and a negative predictive value (NPV) of 78.5% for DDH. Conclusion Excessive hip abduction is an useful and important clinical sign of DDH. Doctors who perform the first examination of the child after birth, would have to turn their attention to this clinical sign. The newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.