Background/aim: Hemodialysis patients face a high burden of cardiovascular diseases, which account for over 40% of mortality in this population. In these patients, approximately two-thirds of cardiovascular deaths are due to arrhythmia. The aim of this study was to determine whether the ultrafiltration rate is associated with morphological and functional parameters of the left heart and arrhythmias. Methods: This work was a cross-sectional observational clinical study, with 75 hemodialysis patients. Patients were divided into two groups based on ultrafiltration rate (UFR): higher-UFR group, ultrafiltration rate ≥ 10 mL/kg/h (n = 37); lower-UFR group, ultrafiltration rate < 10 mL/kg/h (n = 38). All patients were analyzed for myocardial morphological and functional parameters and arrhythmias. Results: Statistically significant higher values were observed for the left atrium diameter (LAD) (47.56 ± 4.82 vs. 44.75 ± 2.33 mm, p = 0.0019), the left atrial volume index (LAVI) (43.28 ± 7.13 vs. 36.43 ± 8.52 mL/m2, p = 0.0003), and the left ventricular mass index (LVMI) (138.47 ± 29.32 vs. 116.04 ± 31.64 g/m2, p = 0.0021) in the higher-UFR group. UFR was associated with LAD (OR: 3.6000, 95% CI: 1.3780–9.4053, p = 0.0089), LAVI (OR: 4.1067, 95% CI: 1.5478–10.8956, p = 0.0045), and LVMI (OR: 4.7619, 95% CI: 1.6825–13.4774, p = 0.0033). The frequency of ventricular and supraventricular arrhythmias was similar between the analyzed patient groups. Conclusions: Higher UFR was associated with structural changes in the left heart (LAVI, LAD, and LVMI), but not with other echocardiographic parameters or arrhythmias in hemodialysis patients.

OBJECTIVE Contemporary surgical risk data from Southeastern Europe are limited. We assessed cumulative surgical probabilities, independent predictors of surgery, and the impact of evolving therapeutic strategies in a Bosnian tertiary referral cohort. METHODS This retrospective cohort study included 153 patients with Crohn's disease treated at University Clinical Center Tuzla between 2009 and 2023. Calendar-period analysis estimated contemporary surgical risk, while natural-history analysis characterized progression from diagnosis. Sequential multivariable Weibull regression identified independent predictors of time to first surgery. RESULTS Cumulative probabilities of surgery at 1, 5, and 10 years were 3, 11, and 34%, respectively. Five factors independently reduced surgical risk. Early biologic therapy showed the largest effect (hazard ratio: 0.22, 95% confidence interval: 0.07-0.73; P = 0.014), followed by colonic location (hazard ratio: 0.37, 95% confidence interval: 0.16-0.81; P = 0.014), inflammatory phenotype (hazard ratio: 0.53, 95% confidence interval: 0.32-0.85; P = 0.011), diagnosis during the biologic era (≥2017; hazard ratio: 0.56, 95% confidence interval: 0.35-0.88; P = 0.013), and early azathioprine initiation (hazard ratio: 0.61, 95% confidence interval: 0.40-0.93; P = 0.022). Sequential modeling confirmed additive protective effects of therapeutic exposures. Early surgery was associated with lower subsequent biologic use than no early surgery (27.5 vs. 81.4%; P < 0.001). CONCLUSION Surgical risk in this Southeastern European cohort aligns with Western estimates. Colonic location and inflammatory phenotype were intrinsic protective factors, whereas early azathioprine, early biologic therapy, and biologic-era diagnosis independently reduced surgical risk. These findings support early combined therapy for high-risk patients.

Background Proton pump inhibitors (PPIs) are widely used for the treatment of acid-related disorders, but inappropriate or prolonged use carries potential health risks. Physicians, due to their access to medication and clinical knowledge, may be prone to self-medicating with PPIs without appropriate oversight. Objective To assess the prevalence and patterns of personal PPI use and self-medication among practicing physicians in Bosnia and Herzegovina, and to identify demographic and professional predictors of such behavior. Methods A cross-sectional, questionnaire-based survey was conducted among 448 physicians who responded to the study invitation, out of approximately 600 invited, from various healthcare levels in Bosnia and Herzegovina between January and May 2025. The survey collected data on PPI use history, consultation behavior, awareness of adverse effects, and adherence to treatment guidelines. Multivariable logistic regression was used to identify independent predictors of self-medication. Results A total of 65.4% of respondents reported past PPI use, during their medical practice, and 31.7% were current users. Over half (52.2%) admitted using PPIs without consulting another physician, and only 17.4% referred to clinical guidelines prior to use. Occasional use was the most common pattern (59.0%), while adverse effects were rarely reported (1.8%). No demographic or professional variable was significantly associated with self-medication with PPIs (defined as PPI use without consulting another physician) in the multivariable analysis. Conclusion Self-medication with PPIs is highly prevalent among physicians and frequently occurs without clinical consultation or adherence to guidelines. This behavior appears to be widespread across age groups, sexes, and care levels, highlighting the need for institutional interventions that promote rational prescribing and raise awareness about responsible self-care within the medical profession.

Bariatric surgery has emerged as the most effective treatment for morbid obesity, offering substantial and sustained weight loss and improvement in comorbid conditions. This paper reviews the development, implementation, and outcomes of bariatric surgery at the University and Clinical Centre Tuzla based on a retrospective analysis of patients who underwent bariatric surgery over a three-year period. A significant weight loss was observed, postoperative complications were minimal, with no in-hospital mortality. The bariatric surgery program demonstrates a significant progress in treating morbid obesity in Bosnia and Herzegovina.

AIM To determine the normative range of ultrasound dimensions for the liver, spleen and kidneys in healthy children according to gender, age, body measurements, body surface area (BSA), and the influence of ethnicity on organ size. METHODS The prospective study included children, ranging from full-term neonates to children aged 15, with normal ultrasonographic (US) findings of the liver, spleen and kidney and no clinical evidence of a disease. Gender, age, as well as body measurements and BSA, were determined for each child along with US measurements, and normative ranges were established. RESULTS US images of the liver and spleen from 372 children and 366 US images of kidneys of 366 children were included. US measurements of the liver, spleen and kidney correlated well with gender, age, body weight and height, and often differed to a greater or lesser extent from the normal range of measurements (5th to 95th percentile) reported in other studies. CONCLUSION Our results differed slightly from other reports conducted in Europe, but larger differences compared to measurements performed on children on other continents were found. Thus, our study confirmed that ethnically appropriate and modern tables of normal ultrasound dimensions for the liver, spleen and kidneys should be used, and that the national nomogram is justified.

Prediction of short-term mortality in patients with acute decompensation of liver cirrhosis could be improved. We aimed to develop and validate two machine learning (ML) models for predicting 28-day and 90-day mortality in patients hospitalized with acute decompensated liver cirrhosis. We trained two artificial neural network (ANN)-based ML models using a training sample of 165 out of 290 (56.9%) patients, and then tested their predictive performance against Model of End-stage Liver Disease-Sodium (MELD-Na) and MELD 3.0 scores using a different validation sample of 125 out of 290 (43.1%) patients. The area under the ROC curve (AUC) for predicting 28-day mortality for the ML model was 0.811 (95%CI: 0.714- 0.907; p < 0.001), while the AUC for the MELD-Na score was 0.577 (95%CI: 0.435–0.720; p = 0.226) and for MELD 3.0 was 0.600 (95%CI: 0.462–0.739; p = 0.117). The area under the ROC curve (AUC) for predicting 90-day mortality for the ML model was 0.839 (95%CI: 0.776- 0.884; p < 0.001), while the AUC for the MELD-Na score was 0.682 (95%CI: 0.575–0.790; p = 0.002) and for MELD 3.0 was 0.703 (95%CI: 0.590–0.816; p < 0.001). Our study demonstrates that ML-based models for predicting short-term mortality in patients with acute decompensation of liver cirrhosis perform significantly better than MELD-Na and MELD 3.0 scores in a validation cohort.

Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), necessitates effective management strategies. This study aims to evaluate the real-world efficacy of vedolizumab, a newer biological therapy, in treating IBD in Bosnia and Herzegovina. A retrospective observational study was conducted across six medical centers, involving 139 IBD patients, 76 with UC and 63 with CD. Patients were assessed for clinical remission and other outcomes at the 26-week mark post vedolizumab treatment initiation. At 26 weeks, clinical remission was achieved in 82.9% of UC patients and 85.7% of CD patients. Mucosal healing was observed in 38.1% of CD patients. The efficacy of vedolizumab did not significantly differ based on prior anti-tumor necrosis factor (anti-TNF) exposure. Notably, the clinical scoring tools for predicting vedolizumab response showed limited applicability in this cohort. Vedolizumab demonstrated high efficacy in treating both UC and CD in real-world settings in Bosnia and Herzegovina, underscoring its potential as a significant therapeutic option in IBD management.

Simple Summary The manual measurement of ablation zones (AZs) in radiofrequency ablation (RFA) therapy is prone to inaccuracies, highlighting the need for automated methods. Our study investigated the effectiveness of an Artificial Intelligence (AI) model, Mask2Former, in automating AZ measurements from ultrasound images, comparing its performance against manual techniques. Conducted on chicken breast and liver samples, the study found the AI model to achieve high accuracy, particularly in chicken breast tissue, with no significant difference in measurements between AI and manual methods. These results suggest that the Mask2Former model can significantly reduce variability in manual measurements, marking a step forward in the automation of AZ measurement in RFA therapy research and potentially improving the precision of treatment assessments. Abstract Background: The accurate delineation of ablation zones (AZs) is crucial for assessing radiofrequency ablation (RFA) therapy’s efficacy. Manual measurement, the current standard, is subject to variability and potential inaccuracies. Aim: This study aims to assess the effectiveness of Artificial Intelligence (AI) in automating AZ measurements in ultrasound images and compare its accuracy with manual measurements in ultrasound images. Methods: An in vitro study was conducted using chicken breast and liver samples subjected to bipolar RFA. Ultrasound images were captured every 15 s, with the AI model Mask2Former trained for AZ segmentation. The measurements were compared across all methods, focusing on short-axis (SA) metrics. Results: We performed 308 RFA procedures, generating 7275 ultrasound images across liver and chicken breast tissues. Manual and AI measurement comparisons for ablation zone diameters revealed no significant differences, with correlation coefficients exceeding 0.96 in both tissues (p < 0.001). Bland–Altman plots and a Deming regression analysis demonstrated a very close alignment between AI predictions and manual measurements, with the average difference between the two methods being −0.259 and −0.243 mm, for bovine liver and chicken breast tissue, respectively. Conclusion: The study validates the Mask2Former model as a promising tool for automating AZ measurement in RFA research, offering a significant step towards reducing manual measurement variability.

Aim To evaluate Helicobacter pylori (H. pylori) resistance to clarithromycin and quinolones in patients with dyspepsia in Tuzla Canton, Bosnia and Herzegovina, a region with no data on clarithromycin or quinolones resistance. Methods A prospective cross-sectional study was conducted at the Department of Gastroenterology and Hepatology at University Clinical Centre Tuzla between January 2021 and June 2022. The study included 99 patients who underwent esophagogastroduodenoscopy (EGDS) due to dyspepsia. In all patients biopsies were taken for rapid urease test (RUT) and histology findings, concomitantly with blood samples for IgG serology. All RUT positive patient samples were tested for clarithromycin and quinolones susceptibility with GenoType HelicoDr, a PCR method which detects point mutations in 23S rRNA and mutations in the gyrA gene. Results Out of 99 dyspeptic patients, 67 (67.7%) were serologically positive to H. pylori, 46 (46.4.%) were RUT positive, and 19 (19.2 %) had a positive histology finding. Antibiotic (AB) resistance was tested in the total of 46/99 (46.4%) patients. Resistance to clarithromycin was detected in 28.26% (13/46), quinolones resistance in 36.96% (17/46) , and resistance to both AB was detected in 8.69% (4/46) tested biopsies. Conclusions Due to high clarithromycin and quinolones resistance rates, we recommend the use of bismuth quadruple or non-bismuth concomitant quadruple therapy for H. pylori eradication in Tuzla Canton, Bosnia and Herzegovina.

In this work, I analyze Nietzsche’s concept of the affirmation of life as one of the main concepts of his philosophy in general. To overcome the pessimism and decadence modern culture has fallen into, Nietzsche construes the concept of the affirmation of life as its main goal and imperative. Hence, for each individual, it is necessary to affirm life by achieving their own autonomy, i.e. pathos of distance. Only by achieving genuine pathos of distance, would human beings be able to overcome pessimism.