PEComa (Perivascular epithelioid cell tumors) are a rare type of tumor composed of cells exhibiting characteristics of smooth muscle cells and melanocytes. They most commonly occur in the female genital system. This study is a narrative review based on the differential diagnosis of tumors in the female genital system, focusing on PEComa. The aim of the research is to analyze the immunohistochemical markers characteristic of PEComa in the female genital system and compare them with markers of tumors that may appear in the differential diagnosis. Specifically, the study examines epithelioid smooth muscle tumor (STUMP), malignant melanoma, alveolar soft part sarcoma (ASPS), poorly differentiated endometrial carcinoma (EC) and trophoblastic tumors of the placenta (PSTT). Comparison of immunohistochemical markers of PEComa with markers of other tumors revealed that: PEComas show overlap in positive staining with STUMP, but are distinguished by markers such as HMB45, PNL2, MiTF, and MelanA/MART1; PEComas share some melanocytic markers with malignant melanoma, but differ in the expression of myogenic markers and hormone receptors; compared to ASPS, PEComas share some positive staining but differ in marker expression and negative staining; they differ from EC by the expression of specific markers such as MiTF and PAX8; PSTT show specificity for markers of trophoblastic differentiation and implantation, while PEComas emphasize melanocytic and myogenic differentiation. The general conclusion is that an accurate diagnosis of PEComa in the female genital system can only be achieved through a multidisciplinary approach. Immunohistochemical evaluation serves as a helpful tool, but standard morphological staining remains the gold standard. Also, the advanced diagnostic techniques, particularly next-generation sequencing, hold promise for enhancing the understanding and management of mPEComas. By uncovering the genomic landscape and facilitating targeted therapies, these methodologies may lead to more effective treatment and improved outcomes. Keywords: female genital system, epithelioid smooth muscle tumor, malignant melanoma, endometrial carcinoma, trophoblastic tumor.

Background HLA-A gene is one of the most polymorphic loci in human genome and its variants influence disease susceptibility and immune checkpoint inhibitor (ICI) therapy response. HLA-A*03 allele has been identified as a biomarker associated with poor ICI response. Objective This study aimed to characterize HLA-A allele and genotype frequencies in the Bosnian population, assess sex specific differences, and evaluate the prevalence of HLA-A*03. Methods Blood samples from 75 individuals were analyzed. Genomic DNA was isolated using the Miller method, and HLA-A typing was performed using PCR with sequence specific primers (PCR-SSP). Polymorphism parameters were calculated using PowerMarker v3.25. Differences between males and females were assessed using chi square and Fisher's exact tests. Results Twelve HLA-A allelic groups and 28 genotypes were identified. The most frequent alleles were HLA-A*02 (33.33%), A*01 (16.67%), A*24 (11.33%), A*03 (10%), and A*11 (8%). The most common genotypes were HLA-A*01/*02 (12%), A*02/*02 (12%), and A*02/*03 (8%). Females showed significantly higher frequencies of HLA-A*02, A*03, and A*31, as well as genotypes HLA-A*02/*03, A*02/*11, and A*02/*31. The population exhibited high polymorphism (heterozygosity 0.8667; gene diversity 0.8232; PIC 0.8054). Strong similarity with European and Western groups and substantial divergence from East Asian and African populations were detected. Conclusion The Bosnian population demonstrates high HLA-A polymorphism, with HLA-A*02 as the most common allele. Females more frequently carry the HLA-A*03 allele and several related genotypes, suggesting potential sex specific implications for ICI therapy response. These findings provide a foundation for future studies investigating the clinical relevance of HLA-A variation in Bosnian cancer patients undergoing immunotherapy.

Background: Evaluated values of body mass index (BMI), waist circumeference (WC) and waist-to-hip ratio (WHR) increase the risk of stroke, but the extent to which this is mediated by hypertension, diabetes, lipid status, smoking and alcohol consumption is not fully understood. Objective: The aim of this research is to examine the influence of modifying and non-modifying factors as well as obesity defined through BMI, WC and WHR on the occurrence of stroke. Methods: A total of 440 subjects were included in the cohort divided in to two groups. The first group were patients with stroke and another without stroke. We investigate modifable factor for stroke (hypertension (HTA), lipid status, diabetes mellitus (DM), smoking, alcohol consumption, educational status) as well as WHR, BMI and WC as determinants for obesitiy. Results: The majority of respondents in both groups had a secondary level of education. Smoking and alcohol consumption were slightly more prevalent in the group without stroke, while HTA and DM were slightly more prevalent in the group with stroke, but without a statistically significant difference. The largest number of respodents without stroke had HDL cholesterol values in the range of optimal >1.5, 70.9%, while 35.5% of respodents with stroke had values in the risk range, as well as 32.3% in the high risk range. LDL cholesterol values were on average statistically significantly higher in the group of respodents with stroke - 3.77±1.29 compared to the values in respodents without stroke - 3.20±1.20. The largest WC had patients with a hemorrhagic stroke 96.4 ± 15.5 cm. The average BMI was slightly higher in the group of patients with embolic stroke (28.5 ± 2.8) compared to patients with hemorrhagic stroke (28.4 ± 5.9) and thrombotic stroke (28.1 ± 4, 2). WHR was almost identical in all three types of stroke. Conclusion: There is correlation between modifable risk factor and obesity in stroke occurence.

Background: Pregabalin is a first-line therapy of pain with additional positive effects on the states of depression and anxiety that often occur in patients with chronic pain, thus improving their quality of life. Objective: The aim of this study was to demonstrate the efficacy of pregabalin in reducing neuropathic pain and improving quality of life in patients with peripheral and central chronic neuropathic pain in Bosnia and Herzegovina. Also, the aim was to monitor the safety of therapy with pregabalin. Methods: The study included patients with neuropathic pain lasting more than 3 months. Based on the underlying disease, patients were divided into 5 groups: DM–patients with diabetes mellitus, M–patients after stroke, D–patients with lower back pain, MS–patients with multiple sclerosis, and P group–patients with spinal cord injury. During the baseline visit, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was used to assess neuropathic pain. During two follow-up visits (1.5 and 3 months after baseline), the 36-Item Short-Form Health Survey (SF 36) was used to assess the effectiveness of therapy on quality of life. The safety of the treatment was evaluated by monitoring the incidence of adverse drug reactions. Results: The study included 125 patients. During treatment with pregabalin, there was a statistically significant reduction in pain intensity in the DM, M, D and MS groups. In group P, the decrease in pain intensity was not statistically significant (p = 0.070). There was a significant improvement in different parameters of the quality of life in all analyzed groups, with the most prominent effects in the DM group. The effectiveness of treatment was rated as “good” and “very good” in more than 70% of subjects in each group. The expected side effects of treatment were recorded in 27.1% of patients in the DM group, in 20.0% in the M group and in 22.2% in the MS group. Unexpected side effects of treatment were observed in one patient (2.1%) in the DM group. Assessment of tolerability of the applied treatment showed “good” and “very good” response in 68.7% of patients in DM group, 73.3% in M group, 74.5% in D group, 88.9% in MS group and 85.8% in P group. Conclusion: Pregabalin is a safe and effective drug in treatment of neuropathic pain of different etiology.

Objective. This study aimed to evaluate the efficacy and safety of lysozyme-based oral antiseptic in the therapy of non-infectious sore throat in teachers. Materials and Methods. A non-interventional, prospective, pilot study was conducted with two examinations. The first was performed as part of a general medical examination. If a non-infectious sore throat was confirmed by clinical checkup and all other inclusion and non-exclusion criteria confirmed, patients were offered to be enrolled in the study. After signing the informed consent form, patients were advised to use lysozyme-based lozenges, six times a day, for a period of five days. A telephone call follow-up examination was performed within 24 hours from the therapy completion. Results. This was a pilot study involving 25 adult patients of both genders. Lysozyme-based lozenges showed positive effects in relieving the symptoms of non-infectious sore throat in teachers. At the same time, the lozenges showed excellent tolerability, and no side effects were reported during the study. 92% of patients confirmed they would take the same medicine again due to the same problem. Conclusion. The results of this “proof-of-concept” study indicated that lysozyme-based antiseptic could be effective and safe in the treatment of non-infectious sore throat in teachers and should be further evaluated as treatment option in this condition.

OBJECTIVE The aim of this study was to assess the relationship between the use of neuroenhancing substances, exam anxiety and academic performance among first-year Bosnian-Herzegovinian (BH) university students. METHODS In a cross-sectional study, an ad hoc questionnaire was delivered to a sample of BH first-year university students. The following data were collected: socio-demographic features, consumption of neuroenchancing substances, the Westside Test Anxiety Scale (WTAS) and academic performance. RESULTS A total of 214 students were included. Consumption of lifestyle substances, coffee, energy drinks, nicotine, alcohol, and marijuana, for the purpose of neuroenhancement increased during the week before the exams. OTC cognitive enhancer use was reported by 31.0%, and of benzodiazepines by 1.5% of students. No psycostimulants were used. A high to extremely high exam WTAS score was reported in 38.3% students. The exam WTAS score was positively correlated with consumption of coffee (rho=0.31; P<0.001), energy drinks (rho=0.18; P=0.009), and nicotine (rho=0.22; P=0.001), and negatively correlated with last exam grade (rho=-0.33; P<0.001). The exam WTAS score was a significant independent predictor (OR=0.55; 95% CI 0.31 to 0.97, P=0.039) for self-assessed academic performance. Self-assessed academic performance was positively correlated with last exam grade (rho=0.15; P=0.043). CONCLUSIONS Although first-year BH university students do not seem to use either prescription or illicit psycostimulants, the consumption of nicotine, alcohol, and marijuana is worrying. However, the consumption of these neuroenhancing substances seems not to be related to better self-assessed academic performance. Finally, exam anxiety seems to be a significant problem among BH first-year university students.

Introduction: Hypertension is significantly contributing to global mortality and morbidity and has been identified as the most important modifiable risk factor for early development of cardiovascular diseases (CVD). Aim: The aim of this study was to investigate the efficacy of different combinations of antihypertensive therapy on blood pressure, arterial stiffness and peripheral resistance in patients with essential hypertension using the brachial oscillometric ambulatory blood pressure monitor. Methods: This study was designed as an observational, prospective, multi centric study conducted in eight primary care centers of the Health Center of Canton Sarajevo during the period of six months. The study included 655 participants, both genders, aged between 30 and 75, who were diagnosed with hypertension according to the ESC/ESH guidelines. Participants were divided into six treatment groups based on the hypertensive drug therapy they were using; lisinopril, losartan or valsartan alone or in combination with hydrochlorothiazide (A, B and C group respectively) or combination of lisinopril, losartan or valsartan with/without hydrochlorothiazide together with amlodipine (D, E and F respectively). The participants were monitored at baseline, after 3 and 6 months (1st and 2nd follow-up). Brachial oscillometric ambulatory blood pressure monitor was used for measuring systolic (SBP), diastolic (DBP), pulse pressure (PP), pulse wave velocity (PWV) and peripheral resistance (PR). Results: SBP, DPB, PP, and PWV significantly decreased from baseline to 2nd follow-up in all treatment groups. The mean reductions in SBP were from -11.7 (95%CI; 9.3- 14.1) to -23.2 (95%CI; 18.3-28.1) mmHg and DBP reductions varied from -5.5 (95%CI; 3.9- 7.1) to -13.4 (95%CI; 7.7-19.1) mmHg. PWV decreased in all treatment groups (from -3.3% to -8.2%). Treatment regiment was not associated with significant differences in SBP, DBP, PP or PWV reductions or their values measured at 2nd follow-up. Peripheral resistance significantly decreased only in group C (p=0.011), group D (p=0.009) and group F (p=0.027). Conclusion: These data suggest that lisinopril/lisinopril + hydrochlorothiazide, losartan/losartan + hydrochlorothiazide and valsartan/valsartan + hydrochlorothiazide alone or in combination with amlodipine are equally effective and well tolerated for the reduction of both systolic and diastolic blood pressure and improve arterial stiffness in patients with essential hypertension.

Introduction: Quality of life in patients with acute pharyngitis or tonsillitis is significantly lower than in healthy persons, and it should be taken into account when efficacy of new therapeutic options is investigated. Objective: The aim of this study was to develop and validate a reliable instrument that can measure quality of life in adult outpatients with sore throat caused by acute pharyngitis or acute tonsillitis. Method: The study was of a cross-sectional type, and assessed reliability and validity of newly developed questionnaire for measurement of quality of life in adult outpatients with sore throat (STQoL) caused by acute pharyngitis or acute tonsillitis. It was conducted on a sample of 282 patients, with mean age 39.0 ± 14.8 years, male/female ratio 104/178 (36.9%/63.1%). Results: Final version of the STQoL scale with 21 items showed excellent reliability, with Cronbach’s alpha 0.949. It was temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains, Social/psychic aspects, Physical aspects and Environmental aspects of sore throat related quality of life. Conclusions: The STQoL scale is reliable and valid specific instrument for measuring sore throat related quality of life, which is an important treatment outcome in patients with acute pharyngitis or tonsillitis.