AIM To assess fatigue severity in patients with rheumatoid arthritis (RA) using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale and to examine its association with demographic, socioeconomic, clinical, and lifestyle-related factors. METHODS This cross-sectional observational study included 90 adults with RA. Fatigue was assessed using the FACIT-F scale, and disease activity was assessed using the Disease Activity Score in 28 joints (DAS28). Continuous variables were summarised as medians and interquartile ranges (IQRs). Associations were evaluated using Spearman correlation, Mann-Whitney U, Kruskal-Wallis, and robust linear regression analyses. RESULTS The median FACIT-F score was 37.0 [IQR 27.0 - 45.0], and 35.6% of patients had moderate-to-severe fatigue. FACIT-F correlated negatively with DAS28 (ρ = -0.381; p < 0.001). In multivariable robust regression, DAS28 remained associated with FACIT-F score after adjustment for age and disease duration (β = -3.54; 95% confidence interval -5.39 to -1.68; p < 0.001), whereas age and disease duration were not significant. FACIT-F scores differed by sex and employment status but not by treatment category. CONCLUSION Fatigue is a prevalent and clinically important symptom in RA. Higher disease activity was associated with greater fatigue severity, supporting comprehensive assessment of fatigue beyond inflammatory disease activity alone.

AIM To evaluate the prognostic value of the CHA2DS2-VASc score in relation to major adverse cardiovascular events (MACE) and cardiovascular mortality in patients with non-ST elevation myocardial infarction (NSTEMI), and to assess its association with clinical and echocardiographic characteristics. METHODS This prospective, observational, cohort study included 311 NSTEMI patients admitted to the Internal Medicine Clinic at the University Clinical Centre Tuzla between January 2023 and April 2024. The patients were stratified into intermediate-risk (score < 4) and high-risk (score ≥ 4) groups based on the CHA2DS2-VASc score at admission. Demographic, clinical, and echocardiographic data were collected, including electrocardiography (ECG) and transthoracic echocardiography. All patients were followed for 3 months (90 days) to assess the occurrence of MACE and cardiovascular mortality. RESULTS The patients in the high-risk group were older and had significantly lower left ventricular ejection fractions and larger left atrial diameters compared with the intermediate-risk group. During the 3-month follow-up, MACE occurred in 11.9% of high-risk and 3.9% of intermediate-risk patients; cardiovascular mortality was observed exclusively in the high-risk group (2.5%). A higher CHA2DS2-VASc score was significantly associated with cardiovascular mortality (p = 0.003), but not with overall MACE (p = 0.393). Moderate predictive accuracy for mortality (AUC = 0.64) and shorter event-free survival in the high-risk group (log-rank p = 0.005) were observed. CONCLUSION The CHA2DS2-VASc score showed potential as a simple and accessible tool for early identification of NSTEMI patients at risk of cardiovascular death. Its significant association with mortality supports its role as a supplementary risk stratification tool, although these findings require validation in larger, multicentre studies.

AIM To compare outcomes of elective open inguinal hernia repair under local anaesthesia (LA) and general anaesthesia (GA). METHODS This retrospective cohort included 833 adults treated in Tuzla during 2017-2025. The primary outcome was any early adverse outcome within 30 days. Secondary outcomes included analgesic requirement, chronic groin pain, discomfort, dissatisfaction, and recurrence. Logistic regression adjusted for age, American Society of Anesthesiologists physical status, hernia characteristics, and technique. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported; Benjamini-Hochberg correction was applied to secondary outcomes. RESULTS The LA group included 425 patients and the GA group 408. Postoperative analgesia was required in 338 (79.5%) and 110 (27.0%) patients, respectively (p<0.001). An early adverse outcome occurred in 79 (18.6%) and 35 (8.6%) patients (aOR 2.08, 95% CI 1.31-3.30; p = 0.002), mainly because of more haematomas with LA, 54 (12.7%) versus 20 (4.9%) (p < 0.001). Chronic groin pain did not differ after adjustment (aOR 1.26, 95% CI 0.81-1.96; p = 0.310). Dissatisfaction was higher with LA, 85 (20.8%) versus 40 (10.1%) (aOR 1.95, 95% CI 1.27-2.99; p = 0.002). Eight recurrences were recorded. Median follow-up was 14 months (interquartile range 12-18 months). CONCLUSION LA was associated with more early adverse outcomes and dissatisfaction than GA. Chronic pain did not differ after adjustment, and recurrence was similar. Selection bias and residual confounding should be considered.

AIM To determine the prevalence of irritable bowel syndrome (IBS)-related symptoms and associated factors among medical students in Bosnia and Herzegovina. METHODS This cross-sectional online survey included 176 medical students from the universities of Sarajevo and Zenica between November 2022 and December 2023. IBS-related symptoms were assessed using the Serbian-language Rome III questionnaire, and test anxiety using the Westside Test Anxiety Scale. Categorical variables were compared using Pearson's χ² test. RESULTS Eighty-four students (47.7%) met the symptom-based Rome III criteria. The IBS-related symptoms group included 75 females (89.3%) compared with 54 (58.7%) in the comparison group (p<0.001). Sweets consumption at least four times weekly was reported by 53 (63.1%) and 45 (48.9%) students, respectively (p = 0.021). Test-anxiety distributions differed between groups (p < 0.001); extremely high anxiety was reported by 12 (14.3%) students with IBS-related symptoms and one (1.1%) without symptoms. Other sociodemographic and lifestyle characteristics were not associated with IBS-related symptoms. CONCLUSION IBS-related symptoms were frequent in this medical-student sample and were associated with female sex, frequent sweets consumption, and test anxiety. The cross-sectional, self-reported design precludes causal interpretation and clinical confirmation of IBS.

Background/Objectives: Early risk stratification remains challenging in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The present study evaluated the prognostic value of 24 h high-sensitivity cardiac troponin I (hs-Troponin I) and assessed whether combining biomarkers and echocardiographic parameters improves short-term risk prediction. Methods: This prospective observational cohort study included 170 consecutive adult patients with confirmed NSTEMI who were admitted to a Medical Intensive Care Unit and prospectively enrolled between February 2022 and January 2023. Clinical, routine biochemical, inflammatory, hematological, lipid, and echocardiographic data were collected during index hospitalization. High-sensitivity cardiac troponin I was measured at admission and again 24 h after hospitalization, with the 24 h value used as the principal marker of myocardial injury in the prediction analyses. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, recurrent myocardial infarction, ischemic stroke, urgent coronary revascularization, or hospitalization for worsening heart failure, within 3 months. Multivariable logistic regression, Cox regression, sequential prediction modeling, and internal bootstrap validation were performed. Results: MACEs occurred in 88 patients (51.8%). Twenty-four-hour hs-Troponin I, but not admission hs-Troponin I, was independently associated with MACEs (OR 1.57, 95% CI 1.09–2.26; p = 0.015) and a shorter time to the first MACE event (HR 1.38, 95% CI 1.07–1.78; p = 0.012). Lower left ventricular ejection fraction (LVEF) was also independently associated with adverse outcomes. The addition of 24 h hs-Troponin I, LVEF, and C-reactive protein improved discrimination from an AUC of 0.665 to 0.759 (optimism-corrected AUC, 0.717), with corresponding improvements in reclassification. A simplified multimarker score was independently associated with event-free survival (HR 2.36, 95% CI 1.53–3.64; p < 0.001). Conclusions: In patients admitted to a medical intensive care unit with NSTEMI, the integration of 24 h hs-Troponin I, LVEF, and C-reactive protein improved short-term risk prediction beyond that of clinical variables alone. A practical multimarker model based on routinely available parameters identified patients at increased risk of adverse cardiovascular outcomes during early follow-up.

This paper presents a comparative analysis of the production and economic results of Holstein-Friesian and Simmental cows on a modern dairy farm in Bosnia and Herzegovina. The research was conducted on a sample of 30 pregnant heifers of each breed, imported from Denmark and Austria, and kept under identical farm conditions. The analysis included age at first calving, milk production in the first lactation, revenue structure, variable costs, and gross margin. Data were obtained from the farm’s electronic production database, while descriptive statistics, a two-sample t-test, and gross margin analysis were used. The results showed that Holstein-Friesian cows achieved higher milk production, with an average daily yield of 34.52 litres compared to 28.39 litres in Simmental cows. This difference was statistically significant. Holstein-Friesian cows also achieved a higher total milk yield and higher gross margin. However, the Simmental breed generated higher additional income from the sale of male and female young cattle and culled cows, confirming the economic relevance of its dual-purpose character. Feed costs were the dominant variable cost category in both breeds. 

AIM To determine the prevalence and microbiological profile of ventilator-associated pneumonia (VAP) in mechanically ventilated patients and to assess clinical and laboratory parameters associated with its development, with emphasis on C-reactive protein (CRP) levels and duration of mechanical ventilation. METHODS This single-centre prospective observational cohort study included 118 adult patients who required invasive mechanical ventilation for more than 48 hours in the intensive care unit of the University Clinical Centre Tuzla. Patients were classified into VAP and non-VAP groups. Demographic, clinical, laboratory, and microbiological data were collected, and in-hospital outcomes were recorded. Statistical analysis included between-group comparisons, univariate logistic regression, and receiver operating characteristic (ROC) curve analysis. RESULTS VAP was diagnosed in 41 patients (34.7%). Gram-negative pathogens predominated (≈ 85%), with Acinetobacter baumannii identified most frequently (43.9%), followed by Pseudomonas aeruginosa and Klebsiella pneumoniae. Patients with VAP had significantly longer durations of mechanical ventilation (12.5 vs. 7.3 days, p < 0.001) and hospitalisation (19.6 vs. 12.2 days, p < 0.001), as well as higher CRP levels (178.2 vs. 126.4 mg/L, p < 0.001). Reintubation, elevated CRP, leukocytosis, hypercapnia, and prolonged mechanical ventilation were associated with VAP. CRP demonstrated good-to-moderate discriminative ability for VAP (AUC = 0.83). CONCLUSION VAP remains a common and clinically significant complication in mechanically ventilated patients. Elevated CRP levels and prolonged mechanical ventilation may support early clinical suspicion using routinely available parameters.

AIM To analyse patient admission patterns, clinical outcomes, and organisational workload in a medical intensive care unit (ICU), with emphasis on early mortality and post-pandemic changes in healthcare demand. METHODS This retrospective, observational, single-centre cohort study included all adult patients admitted to the medical ICU of the Clinic for Internal Medicine at the University Clinical Centre Tuzla between January 1, 2018, and December 31, 2025. Aggregated data were obtained from the hospital information system and internal ICU records. Analysed variables included annual admission volume, admission sources, discharge outcomes, in-hospital and early mortality (within 24-72 hours after ICU admission), estimated length of stay, invasive procedures, and patient age. Temporal trends were assessed across pre-pandemic (2018-2019), pandemic (2020-2021), and post-pandemic (2022-2025) periods. RESULTS A total of 9,342 ICU hospitalisations were analysed. Admissions remained relatively stable through 2020, declined in 2021, reached their lowest level in 2022, and then increased markedly from 2023 onward. Admissions per bed rose from 67.5 in 2022 to 108.6 in 2025, while the estimated mean ICU length of stay decreased from 5.4 to 3.4 days. Overall, in-hospital mortality was approximately 22%, with 75-80% of deaths occurring between 24 and 72 hours from admission. The patient population was predominantly elderly, with a mean age of approximately 70 years. CONCLUSION Medical ICU services operated under increasing organisational strain, reflected by rising admission volume, higher admissions per bed, and reduced estimated length of stay despite fixed bed capacity. Persistently high early mortality remained a prominent feature of this population.