AIM To investigate the relationship between coronary artery calcium (CAC) score and left ventricular global longitudinal strain (LV GLS) in patients with arterial hypertension who had a negative treadmill exercise stress test but mild to intermediate coronary stenosis on coronary computed tomography angiography (CCTA). METHODS A total of 53 hypertensive patients (mean age 54.8 ± 4.8 years; 50.9% male) with 30-50% coronary stenosis on CCTA were included. Patients with diabetes, malignancy, or established coronary/peripheral artery disease were excluded. CAC score, left ventricular ejection fraction (LVEF, Simpson's method), and LV GLS (speckle-tracking echocardiography) were measured. Groups were stratified by GLS (< 18.5% vs. ≥ 18.5%) and LVEF (< 60% vs. ≥ 60%), and CAC score differences were assessed using the Mann-Whitney U test. RESULTS The median CAC score was 27 (IQR 16-44.5), median LVEF 60% (IQR 58-63%), and mean GLS 19.37 ± 0.89%. No overall association was found between CAC score and LV function by LVEF or GLS. In patients with left anterior descending (LAD) stenosis (30-50%), reduced LV function was linked to significantly higher CAC score. Median CAC score was higher in patients with GLS ≤ 18.5% (157 vs. 44.5; p = 0.019) and LVEF <60% (157 vs. 44.5; p = 0.019). No significant associations were found in right coronary artery (RCA), circumflex artery (Cx), or three-vessel stenosis subgroups. CONCLUSION Higher CAC score in hypertensive patients with mild LAD stenosis and negative stress testing identify those at risk of subclinical LV dysfunction.

AIM To determine if heat-not-burn (HNB) tobacco products are a safe alternative to cigarette smoking by inducing decreased decline of cardiorespiratory function. METHODS A clinical observational, cross-sectional study was conducted in the period between February and June 2025. It analysed and identified the effects of HNB tobacco products on cardiorespiratory symptoms in 60 adults below 55 years of age with confirmed arterial hypertension, 30 in the HNB users group (≥ 6 months of HNB use and no history of conventional cigarette use (CCU)), and 30 in the non-HNB user group (no history of HNB or CCU). RESULTS The gender distribution among the groups was similar. HNB tobacco product users reported significantly more respiratory (daily and nighttime shortness of breath, coughing) and cardiologic symptoms (choking, shortness of breath during physical activity). The following parameters were significantly reduced in the HNB tobacco product users: forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and forced expiratory flow at 75% (FEF75) (p = 0.01), SO2 (p < 0.001), pO2 (p = 0.001), HCO3- (p < 0.001), total cholesterol (p = 0.001), and basophils (p < 0.001), while the following parameters were significantly increased in the same group: right ventricular systolic pressure (RVSP) (p = 0.002), hsCRP (p < 0.001), monocytes (p < 0.001), eosinophils (p < 0.001), D-dimer (p < 0.001), and platelet count (p = 0.003). CONCLUSION HNB tobacco product use in adults with arterial hypertension was associated with worse cardiorespiratory symptoms, impaired pulmonary function, signs of early right ventricular dysfunction, and systemic inflammation.

Background: Noninvasive ventilation (NIV) is a cornerstone treatment for hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the impact of selected comorbidities on the effectiveness of NIV in these patients, and to compare clinical characteristics and outcomes between continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) modalities.Materials and methods: This prospective, randomized, single-center study included 80 patients with hypercapnic respiratory failure due to COPD, randomized 1:1 to CPAP or BiPAP. Demographic and clinical data, comorbidities, vital signs, and arterial blood gas parameters were recorded at admission and during NIV. The primary outcome was pCO₂ reduction at the end of treatment compared with baseline.Results: Arterial hypertension significantly enhanced pCO₂ reduction with CPAP, but not with BiPAP. Systolic and mean arterial pressure independently predicted the magnitude of pCO₂ reduction, regardless of NIV modality. Patients treated with BiPAP more frequently had decompensated cor pulmonale and severe pulmonary hypertension, while pneumonia was more common in the CPAP group. NIV modality itself was not an independent predictor of pCO₂ reduction.Conclusion: Systemic hemodynamic status and arterial hypertension influence NIV effectiveness in hypercapnic COPD. The cardiovascular status should be considered alongside respiratory parameters when selecting the NIV strategy.

Introduction: Type 2 diabetes mellitus (T2DM) is associated with a high burden of complications, most of which first present to primary care.Objective: To assess the prevalence and predictors of diabetes-related complications among patients seeking primary health care.Methods: This retrospective study analysed records of 1000 patients with T2DM in primary care. Demographic, clinical, and therapeutic variables were examined, and multivariate logistic regression was used to identify independent predictors of complications.Results: Majority of the patients (58.3%) had at least one complication. Neuropathy (41.8%), retinopathy (32.3%), and chronic coronary syndrome (CCS)(22.3%) were most frequent. Independent predictors for complications included older age, longer disease duration and higher HbA1c (p<0.001 for all). Neuropathy was significantly associated with female sex (p=0.016), while myocardial infarction and CCS showed significant association with male sex (p=0.027 and p=0.002 respectively). All complications were strongly associated with hospitalisations (all p<0.001), except for retinopathy. Family history independently predicted retinopathy (p=0.039) and CCS (p=0.014).Conclusion: Diabetes-related complications remain highly prevalent and are strongly linked to glycaemic control, disease duration, and age. Sex, and family history also shape complication patterns, while treatment modality reflects disease severity. These findings highlight the need for early, individualised management and implementation of guideline-based strategies to reduce complication burden and improve outcomes in frontline care.

Objective: To describe patient-reported symptoms of hypothyroidism in a primary care cohort and perform an exploratory assessment of potential gender differences. Methods: This retrospective observational study included 1000 patients with confirmed hypothyroidism treated at the Public Institution Health Care Centre Visoko between January and October 2024. Data were extracted from electronic medical records. Collected variables included age, gender, comorbidities, family history, pregnancy status, and reported symptoms. Descriptive statistics were performed for the entire cohort. Exploratory logistic regression analyses were used to assess potential gender differences in reported symptoms. Results: The cohort comprised 921 (92.1%) female and 79 (7.9%) male patients, with a mean age of 57±14.6 years. The most commonly reported symptoms were hyperhidrosis (97%), fatigue (96.6%), and heart palpitations (83.5%). Male patients showed a higher likelihood of reporting heart palpitations (OR 2.42, p=0.03) and bowel problems (OR 2.03, p=0.01), and a lower likelihood of reporting neck tightness (OR 0.26, p<0.001) and tearfulness (OR 0.045, p<0.001). Conclusion: In this primary care cohort, the reported symptom burden was largely nonspecific and reflects real-world patient-reported complaints rather than classical manifestations of overt hypothyroidism. Exploratory analyses suggested potential gender-related differences; however, the low number of male patients limits firm conclusions. Larger prospective studies are needed to confirm these observations.

ObjectiveTo evaluate the predictive value of LA strain parameters and LASI for AF recurrence following electrical CV, and to compare them to conventional echocardiographic, biochemical, and clinical markers.MethodsIn this prospective, observational pilot study, 31 patients with persistent AF underwent electrical CV and were followed for six months. Echocardiographic evaluation included LA reservoir, conduit, and contractile strain, left atrial stiffness index, left atrial volume index (LAVI), left atrial appendage (LAA) morphology, left ventricular ejection fraction (LVEF), right atrial (RA) area, and right ventricular systolic pressure (RVSP). AF recurrence was assessed at three and six months.ResultsAt three months post-CV, LA reservoir, conduit, and contractile strain values were significantly negatively associated with AF recurrence (p < 0.001), while LASI and E/E' ratios were positively associated (p < 0.001). At six months, only contractile strain retained prognostic significance (p = 0.008). LVEF showed a positive correlation with recurrence at six months (p = 0.003), potentially reflecting the role of diastolic dysfunction.ConclusionLA strain parameters and LASI are valuable tools for predicting AF recurrence after CV, particularly in the early post-procedural period. Contractile strain may serve as a more reliable long-term predictor, emphasizing the importance of longitudinal atrial function assessment in rhythm outcome prediction. However, given the small sample size and single-center design, these results should be considered hypothesis-generating, requiring validation in larger studies.

Introduction. Psychiatric disorders frequently co-occur with chronic somatic diseases, trauma, and family psychiatric history. Results. Affective disorders were most prevalent (67%), particularly among women and retirees. Conclusion. Psychiatric diagnoses are closely intertwined with demographic and social factors, trauma, family history, and somatic comorbidities. These findings highlight the need for integrated, multidisciplinary care. Keywords: Age, Comorbidity, Mental Disorders, Sex, Somatic Diseases.

Introduction. Owing to its high incidence and significant impact on public health, breast cancer represents a major clinical and epidemiological challenge. This study aimed to describe the clinicopathological and immunohistochemical characteristics of newly diagnosed breast cancer cases in Sarajevo. Results. Among 10,547 breast examinations, 165 breast cancers were detected (1.5–1.6% annual incidence). Conclusion. This study highlights the heterogeneity of breast cancer and emphasizes the need for further research to refine diagnostics and treatment. Keywords: Breast cancer, Estrogen Receptors, Progesterone Receptors.

Introduction. Morning stiffness (MS) is the hallmark of rheumatoid arthritis (RA) and it has important implications on daily life of the patients. There are conflicting reports of its association with disease activity. Methods. This observational study included 125 patients with seropositive RA from Health Care Center, Visoko. We obtained data on patient’s gender and age, duration of RA, pain in hands and feet, MS and its duration, hospital admission, blood pressure, laboratory values and treatment modalities. Results. MS lasted up to 30 minutes in 71 (56.8%) patients, 30 to 60 minutes in 40 (32%) patients, and more than 60 minutes in 14 (11.2%) patients. There was no difference in the duration of MS between genders. Patients with longer MS were younger and had a longer duration of illness. Patients with MS longer than 30 minutes had higher blood pressure and cholesterol levels. ESR in the second hour and CRP correlated with a duration of MS. Patients on methotrexate had a longer duration of MS. No significant differences in the duration of MS were observed for leflunomide, corticosteroids and supportive treatment modalities. Conclusion. Duration of MS correlates with RA disease activity and remains an important burden for patients. Usage of newer treatment options, such as biologic disease-modifying antirheumatic drugs (DMARDs), may be required. Keywords: biomarkers, disease activity, rheumatoid arthritis.

Introduction: Calciphylaxis (calcific uremic arteriolopathy), is a condition primarily observed in patients with end-stage renal disease (ESRD). Aim: To increase clinical awareness of calciphylaxis and to consider it a differential diagnosis in the presence of atypical skin nodules or ulcers occurring in patients with chronic kidney disease (CKD), especially in patients on hemodialysis and non-hemodialysis patients with the background of diabetes mellitus and secondary hyperparathyroidism. Case Report: We present the case of a 77-year-old woman with CKD and diabetes mellitus as well as severely painful, firm, indurated plaques on the lower extremities. The plaques progressed to involve larger areas with associated local ulceration and necrosis. Laboratory testing revealed hyperparathyroidism and incisional skin biopsy confirmed calciphylaxis. Conclusion: Each single CKD patient with diabetes mellitus and signs of secondary hyperparathyroidism with extremely painful ischemic cutaneous lesions or painful subcutaneous nodules without skin changes, although at times, pain may precede the development of the lesions, is a candidate for skin biopsy. Calciphylaxis is a rare but serious kidney complication. Keywords: calciphylaxis, chronic kidney disease, prognosis, treatment.