Background: Breast cancer remains the most common cancer in women worldwide. Treatment has evolved into multimodal approaches, with pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) serving as a key prognostic marker. The aim of this study was to evaluate the value of inflammatory markers in predicting pCR to NAC in breast cancer. Methods: This cross-sectional study of 74 patients with breast cancer who underwent NAC followed by surgery included demographic, tumor, and immune-inflammatory marker data. Receiver operating characteristic curve analysis and the Youden index were used to determine optimal cutoff values. Univariate and multivariate logistic regression assessed associations between markers and pCR, adjusting for tumor stage, human epidermal growth factor receptor 2 (HER2), and estrogen receptor (ER) status. Results: Our multivariate analysis identified the pan-immune-inflammation value (PIV), HER2 status, and ER status as significant independent predictors of pCR. PIV (OR, 4.28; 95% CI, 1.59–16.88) remained significant among inflammatory markers, while the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) did not. HER2-positive (OR, 7.45; 95% CI, 2.30–24.15) and hormone receptor (HR)–negative (OR, 7.02; 95% CI, 2.63–18.70) statuses were also strongly associated with pCR. Conclusion: PIV is a robust predictor of pCR in patients with breast cancer receiving NAC, offering a comprehensive reflection of the immune-inflammatory state. Incorporating PIV with tumor-specific markers (e.g., receptor status, Ki-67, grade) may enhance treatment stratification. Further validation in diverse cohorts is warranted.

Background/Objectives: In many low- and middle-income countries (LMICs), including Bosnia and Herzegovina, oncology services are constrained by a limited number of specialists and uneven access to evidence-based care. Artificial intelligence (AI), particularly large language models (LLMs) such as ChatGPT, may provide clinical decision support to help standardize treatment and assist clinicians where oncology expertise is scarce. This study aimed to evaluate the concordance, safety, and clinical appropriateness of ChatGPT-generated treatment recommendations compared to decisions made by a multidisciplinary team (MDT) in the management of newly diagnosed breast cancer patients. Methods: This retrospective study included 91 patients with newly diagnosed, treatment-naïve breast cancer, presented to an MDT in Bosnia and Herzegovina in 2023. Patient data were entered into ChatGPT-4.0 to generate treatment recommendations. Four board-certified oncologists, two internal and two external, evaluated ChatGPT’s suggestions against MDT decisions using a 4-point Likert scale. Agreement was analyzed using descriptive statistics, Cronbach’s alpha, and Fleiss’ kappa. Results: The mean agreement score between ChatGPT and MDT decisions was 3.31 (SD = 0.10), with high consistency across oncologist ratings (Cronbach’s alpha = 0.86). Fleiss’ kappa indicated moderate inter-rater reliability (κ = 0.31, p < 0.001). Higher agreement was observed in patients with hormone receptor-negative tumors and those treated with standard chemotherapy regimens. Lower agreement occurred in cases requiring individualized decisions, such as low-grade tumors or uncertain indications for surgery or endocrine therapy. Conclusions: ChatGPT showed high concordance with MDT treatment plans, especially in standardized clinical scenarios. In resource-limited settings, AI tools may support oncology decision-making and help bridge gaps in clinical expertise. However, careful validation and expert oversight remain essential for safe and effective use in practice.

Sex cord-stromal tumors are rare ovarian neoplasms, with fibromas comprising approximately 4% and thecomas accounting for 0.5%–1% of all ovarian tumors. The occurrence of these tumors outside the ovaries is exceptionally rare and diagnostically challenging, often mimicking malignancy when associated with ascites, elevated CA-125 levels, or Meigs-like syndrome. This review aims to synthesize current knowledge on the histopathological, immunohistochemical, radiological, and molecular features of ovarian fibroma-thecoma group tumors and highlight their clinical relevance. We report two postmenopausal women with large abdominal masses located extraovarian: one in the broad ligament and the other adherent to the omentum and intestines. In the first case, markedly elevated CA-125, ascites, and pleural effusion initially suggested Meigs syndrome. The second case presented with an abdominal mass and ascites. Imaging studies indicated the possibility of malignant ovarian tumors in both patients, leading to surgical excision. Histopathological examination revealed spindle-to-oval tumor cells arranged in fascicular or storiform patterns, with focal lipid-rich theca-like cells. Immunohistochemical analysis showed that the tumors were positive for vimentin, WT1, progesterone receptor (PR), and variably for estrogen receptor (ER), CD56, inhibin, and calretinin, while being negative for markers of epithelial, melanocytic, and gastrointestinal stromal tumors. A review of the literature identified only 11 well-documented cases of extraovarian fibroma-thecoma group tumors, which most commonly arise in the broad ligament or pelvic cavity. These cases are frequently associated with ascites and elevated CA-125 levels and are often misdiagnosed preoperatively as malignant disease. Our cases underscore the importance of considering extraovarian fibromas and thecomas in the differential diagnosis of pelvic and abdominal masses presenting with similar features. Accurate pathological assessment can prevent unnecessary radical surgeries and promote more favorable patient outcomes.

Introduction. Sentinel lymph node biopsy (SLNB) has significantly advanced axillary staging in clinically node-negative breast cancer, offering lower morbidity compared to traditional axillary lymph node dissection (ALND). Nonetheless, precise prediction of non-sentinel lymph node (non-SLN) involvement remains essential for optimizing surgical decisions and preventing unnecessary ALND. Methods. A retrospective cohort analysis was performed on 176 patients with clinically node-negative breast cancer who underwent SLNB. Clinicopathological data were reviewed to evaluate associations between various predictive factors and non-SLN involvement. Variables analyzed included tumor size, histological grade, lymphovascular invasion (LVI), Ki-67 proliferation index, and sentinel lymph node characteristics. Results. Multivariable logistic regression identified the type of SLN metastasis (OR=21.4; 95% CI 1.7–43.6; p=0.01), the number of positive SLNs (OR=5.66; 95% CI 1.18–36.6; p=0.03), and the number of negative SLNs (OR=0.04; 95% CI 0.006–0.27; p=0.001) as independent predictors of non-SLN metastases. The predictive model demonstrated excellent discriminatory power, with an area under the receiver operating characteristic curve (AUC) of 0.91. Conclusion. Specific clinical and histopathological variables reliably predict non-SLN involvement in SLN-positive breast cancer patients. Incorporation of these predictors into clinical practice may enhance individualized axillary management and reduce unnecessary ALND procedures. Further validation through larger prospective studies is warranted. Key words: Breast Neoplasms, Sentinel Lymph Node Biopsy, Axillary Lymph Nodes, Lymph Node Dissection, Neoplasm Staging.

DIALOG + is a low-cost intervention proven to improve the subjective quality of life in patients with psychosis and anxiety disorders in low- and middle-income countries. In a recent study, DIALOG + was shown to be feasible for patients in primary care settings with long-term physical conditions and to result in an improvement in patient outcomes. The aim of this qualitative study was to explore the experiences of patients and clinicians using DIALOG + in Bosnia and Herzegovina to gain a better understanding of its impact in this setting. In-depth semi-structured interviews were conducted with 11 patients and 4 physicians, as well as two focus groups with 5 patients in each, all of whom participated in the intervention. Specific life and treatment domains discussed during the sessions between patients and clinicians were also analysed to determine which domains were most frequently addressed and where patients needed the most support. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four qualitative themes were identified: (1) DIALOG + structure and solution-oriented approach are helpful; (2) DIALOG + allows space for conversation; (3) Therapeutic relationship is improved, and (4) The intervention has its limitations. DIALOG + is a novel primary care intervention with positive effects on patients’ lives, which enhance primary care. Nevertheless, it presents a new challenge in this setting. It is necessary to make adjustments in primary care, such as providing clinicians with more extensive training and ongoing support, as well as providing more time for the intervention’s implementation. Study was registered prospectively within the ISRCTN Registry: ISRCTN17003451, 02/12/2020.

INTRODUCTION Acute bacterial meningitis (ABM) is a serious infectious disease and medical emergency. Given the fact of its high mortality and morbidity, detecting prognostic factors is potentially useful in improving treatment strategies. This paper aims to determine prognostic factors of short-term outcomes of patients with ABM in a developing country - Bosnia and Herzegovina, measured by the Modified Rankin Scale (MRS) at discharge. METHODOLOGY In this retrospective cohort study, 56 patients treated at the Clinic of Infectious Diseases, Clinical Center University of Sarajevo, for 11 years (2012-2022) were included. Statistical analysis was performed using IBM SPSS Statistics version 29.0.1.0. RESULTS The subjects' average age was 31.6 ± 27.7 years, with the youngest patient being 4 months and the oldest 75 years old. Among those, 31 were male and 25 were female. Unfavorable outcomes had 16 (28.6%) patients, including fatal outcomes in four patients and severe disabilities in 12 patients (MRS: 2-6), while 40 (71.4%) patients had favorable outcomes (MRS: 0-1). In the multivariate analysis, predictors of unfavorable outcomes included age older than 60 years, duration of symptoms longer than 24 hours, presence of neurological defects at admission, impaired consciousness, respiratory distress, and no corticosteroid use during treatment. CONCLUSIONS There is certainly a window of opportunity for patients with ABM: The shorter the time between disease onset and treatment initiation, the better the disease outcome.

Background/Objectives: Squamous cell lung cancer (SCC) presents a significant treatment challenge due to its poor prognosis and limited therapeutic options. In many resource-limited countries, access to advanced molecular testing is often unavailable, making the identification of novel and reliable prognostic markers crucial for improving patient selection for systemic treatments. Methods: This single-center, retrospective study investigated the prognostic value of inflammatory biomarkers, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in 134 patients diagnosed with SCC. Patients were stratified into groups based on optimal cut-off values determined by ROC analysis for each biomarker. Results: Elevated levels of the SII, NLR, and PLR were significantly associated with shorter overall survival in patients with SCC (all p < 0.05). Conclusions: These easily accessible and cost-effective laboratory parameters are particularly valuable in settings where molecular testing is not available, aiding in the identification of high-risk patients and optimizing treatment selection for chemotherapy.

AIM The position of science and scientific research in Bosnia and Herzegovina (B&H) is unfavourable. University education lacks research programs, hindering students from developing critical evaluation skills. METHODS This cross-sectional study examined knowledge, attitudes, experience and perceived barriers towards scientific research among biomedical students and recent graduates at the University of Sarajevo in B&H. A self-reporting questionnaire was distributed via social networks and among students from all years of the Medical, Dentistry, Pharmaceutical faculties, the Faculty of Health Sciences, and the Faculty of Science, as well as recent graduates. RESULTS The survey was completed by 243 participants. The mean knowledge score of 4.3/11 was noticed; 216 (96%) believed research was necessary for healthcare improvement. Although 147 participants (65.3%) attended courses on research methodology, only 63 (28%) engaged in scientific research at their faculties. Only 5 (8.5%) employed graduates participated in research at their jobs. Almost half, 99 (44%) participants consulted scientific papers only upon recommendation. The majority of participants, 199 (82.2%), reported they experienced barriers to conducting research in B&H. CONCLUSION Biomedical students and graduates demonstrated limited research knowledge, but had positive attitudes and acknowledged significant barriers. Improved faculty curricula in research areas and more opportunities are needed.

Introduction The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. Methods An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. Results A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. Conclusion The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. Trial registration All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).

Background: Chest pain represents a prevalent complaint in emergency departments (EDs), where the precise differentiation between acute coronary syndrome and alternative conditions assumes paramount significance. This pilot study aimed to assess the HEART score’s implementation in West Balkan EDs. Methods: A retrospective analysis was performed on a prospective cohort comprising patients presenting with chest pain admitted to EDs in Sarajevo, Zenica, and Belgrade between July and December 2022. Results: A total of 303 patients were included, with 128 classified as low-risk based on the HEART score and 175 classified as moderate-to-high-risk. The low-risk patients exhibited younger age and a lower prevalence of cardiovascular risk factors. Laboratory and anamnestic findings revealed higher levels of C-reactive protein, ALT, and creatinine, higher rates of moderately to highly suspicious chest pain history, a greater number of cardiovascular risk factors, and elevated troponin levels in moderate-to-high-risk patients. Comparatively, among patients with a low HEART score, 2.3% experienced MACE, whereas those with a moderate-to high-risk HEART score had a MACE rate of 10.2%. A moderate-to-high-risk HEART score demonstrated a sensitivity of 91.2% (95%CI 90.2–93.4%) and specificity of 46.5% (95%CI 39.9–48.3%) for predicting MACE. Conclusion: This pilot study offers preliminary insights into the integration of the HEART score within the emergency departments of the West Balkan region.