Aims: To evaluate the impact of the COVID-19 pandemic on breast cancer presentation, surgical management, and lymph node involvement in a small, understudied population in Brčko District, Bosnia and Herzegovina. Methods: A retrospective cohort study conducted at the General Hospital of Brčko District, Bosnia and Herzegovina, from March 2018 to March 2022. We included 113 patients with histopathologically confirmed breast cancer. We divided the patients into two groups: the before-COVID group (65 patients, including one male) treated from March 2018 to March 2020, and the during-COVID group (47 patients) treated from March 2020 to March 2022. We analyzed patient data (age, gender, menopausal status) along with tumor and lymph node histopathological characteristics. Results: The number of surgeries performed decreased by 16.9% during the COVID period. Patients in the pre-COVID group mostly had grade II tumors, while those in the post-COVID group had predominantly grade III tumors. The average number of lymph nodes sampled was similar between groups (10.70 ± 4.12 before COVID vs. 10.39 ± 4.66 during COVID). Still, the average number of positive lymph nodes was higher in the COVID group (2.5±3.82) compared to the pre-COVID group (1.64±2.90). For patients without neoadjuvant therapy, the average time to surgery increased from 1.04 months (±0.66) before the COVID-19 pandemic to 2.59 months (±2.88) during the COVID-19 pandemic. For those receiving neoadjuvant therapy, time to surgery increased from 5.45 months (±2.97) to 7.29 months (±5.15). Conclusion: The COVID-19 pandemic led to delayed breast cancer management, higher tumor grade, and increased lymph node involvement in a small, resource-limited healthcare setting. Findings highlight the need for resilient oncology services in smaller districts during public health crises.

AIMS: The aim of the study was to investigate the prognostic value of Ki-67 and histological grade in patients with estrogen receptor (ER) positive and human epidermal growth factor receptor 2 (HER2) negative early breast cancer. Although the proliferation activity of different tumors assessed with antigen Ki-67 was extensively studied in the last decade and showed that Ki67 expression was a useful prognostic factor in breast cancer, there is still a controversy about the utility value of Ki-67. METHODS: The retrospective study covered the period from 2016 to 2022. Year included 106 patients from Brcko District, with early estrogen-positive and HER2 receptors-negative breast cancer. The average patients’ age was 62.37 ± 11.65 years. Patients were divided into groups with high/low Ki-67 and high/low histological grade. Multiple linear regression analysis was performed for disease relapse and mortality. RESULTS: Patients with high Ki-67 were more frequent postmenopausal, had higher histological grade, cancer ˂2 cm, more frequent lymph nodes’ metastases, more frequently underwent to axillary surgery, and had a higher mortality rate. Patients with high histological grade were older, more frequent postmenopausal, had more frequent metastases to the lymph nodes, more frequent occurrence of high Ki-67, more frequent relapse of disease, and more frequent of death. CONCLUSION: Combination of high Ki-67 with high histological grade in ER positive and HER2-negative early breast cancer is an important prognostic factor.

Aim: Resection surgery on the colon and rectum are changing both anatomical and physiological relations within the abdominal cavity. Delayed functions of the gastrointestinal tract, flatulence, failure of peristalsis, prolonged spasms and pain, limited postoperative recovery of these patients increase the overall cost of treatment. Early consumption of coffee instead of tea should lead to faster restoration of normal function of the colon without unwanted negative repercussions. Method: This study is designed as a prospective-retrospective clinical study and was carried out at the Surgery Center Tuzla, during the year 2013/ 2014. Sixty patients were randomized in relation to the type of resection surgery, etiology of disease-malignant benign, and in relation to whether they were coffee users or not. Patients were divided into two groups. The first group of thirty patients was given 100 ml of instant coffee divided into three portions right after removing the nasogastric tube, first postoperative day, while the second group of thirty patients got 100 ml of tea. Monitored parameter was: time of first stool and the second group of monitored parameters was: whether there was returning of nasogastric tube or not, increased use of laxatives, whether there was anastomotic leak, radiologic and clinical dehiscence, audit procedures, or lethal outcomes in the treatment of patients. Results: A total of 61 patients were randomized into two groups of 30 int he group of tea and coffee 29 in the group, two patients were excluded from the study because they did not consume coffee before surgery. Time of getting stool in the postoperative period after elective resection surgery on the colon and rectum is significantly shorter after drinking coffee for about 15h (p <0.01). Also, the length of hospital stay was significantly shorter after drinking coffee (p <0.01). Time of hospitalization in subjects/respondents coffee consumers on average lasted 8.6 days with consumers of tea for 16 days. The incidence of postoperative complications was significantly lower after consumption of coffee (p <0.05). Conclusion: Postoperative consumption of coffee is a safe and effective way to accelerate the establishment of the bowel function after colorectal resection surgery.