Graphical abstract

While clear cell renal cell carcinoma (ccRCC) is curable, advanced metastatic (mRCC) remains a clinical challenge. We analyzed clinical, pathohistological, and molecular data (Receptor Interacting Protein 5—RIP5 and Vestigial Like Family Member 4—VGLL4 expression) of 55 mRCC patients treated with first-line treatment with sunitinib. The trend of linear increase in the protein expression of RIP5 was observed with the progression of tumor grade. Overall, 80% of RIP5-positive cells were in the control kidneys and high-grade mRCC. On the contrary, RIP5 displayed low expression in grade 2 mRCC (5.63%). The trend of linear decrease in the expression of VGLL4 was observed with the progression of tumor grade. The highest protein expression of VGLL4 was observed in grade 2 (87.82%) in comparison to grade 3 and 4 and control. High expression of RIP5 mRNA was associated with longer first-line overall survival and longer progression-free survival in mRCC. In addition, a high VGLL4 mRNA expression showed better overall survival in patients with ccRCC. In conclusion, high mRNA expression of RIP5 and VGLL4 are important markers of better survival rates in mRCC patients.

Homocysteine is known to be associated with adverse vascular and metabolic effects, as well as pregnancy complications. Its serum levels are influenced by the function of the enzyme methylenetetrahydrofolate reductase (MTHFR) and the dietary intake of folic acid, vitamin B12, and methionine. In this cross-sectional study, we investigated the association of genetic polymorphisms of the MTHFR gene with vitamin status in pregnant women during mandatory folic acid supplementation. The study included 102 pregnant women between 24 and 28 weeks of gestation who were attending regular outpatient examinations at the maternity clinic. Homocysteine, folic acid, vitamin B12 levels, and MTHFR gene polymorphisms (C677T and A1298C) were analyzed. Significant associations were found between vitamin B12 and folic acid levels with homocysteine (P< 0.001), with lower serum levels of these vitamins being associated with higher homocysteine levels. Surprisingly, there was no significant association between MTHFR genetic polymorphisms and serum homocysteine levels, likely attributed to the supplementation of folic acid and vitamin B12 in vitamin supplements for pregnant women, which counteracts the effect of the mutation. Remarkably, a high prevalence of MTHFR gene mutations was found, with the C677T polymorphism present in 56.9% and the A1298C polymorphism in 87.2% of pregnant women. These findings emphasize the importance of adequate folic acid and vitamin B12 intake during pregnancy to regulate homocysteine levels. Although the MTHFR gene mutations were highly prevalent, their influence on homocysteine levels in this population appears to be mitigated by vitamin supplementation. Further research is warranted to explore the impact of these mutations on other aspects of pregnancy outcomes. The trial is registered at Clinicaltrail.gov (NCT04952324).

Background: Placenta accreta spectrum (PAS) is a clinical term used to describe the abnormal trophoblast invasion into the myometrium of the uterine wall and may enter into the serosa or even into adjacent organs. It is associated with severe obstetric haemorrhage and often requires emergency hysterectomy, which is one of the foremost causes of maternal morbidity and mortality. The vast of these conditions are seen in women with a history of previous caesarean section and placenta previa. Cases: In this study we present two cases of a rare type of PAS, placenta percreta, in women with a history of previous caesarean section (CS). Both instances were diagnosed prenatally, using the method of ultrasound and magnetic resonance imaging. They were scheduled for deliveries by CS, and both were hysterectomized. These diagnoses were confirmed in histopathological findings. Conclusion: Considering sparse published data and absence of well conducted studies, optimal management is still undefined. Caesarean hysterectomy is still the gold standard treatment for placenta accreta spectrum proposed by many societies as an absolute and final treatment.

Aim To evaluate satisfaction of mothers who gave birth at term with received hospital care and to find areas for improvement at a tertiary hospital. Methods A cross-sectional study at the Department of Obstetrics & Gynaecology at the University Clinical Hospital Mostar was conducted by an anonymous survey using a questionnaire designed exclusively for this study. A total of 100 mothers were included in the study. Results Satisfaction with midwives' communication and their approach to the women during their stay in the delivery room was rated significantly higher (4.7±0.6) when compared to obstetricians-gynaecologists (4.5±0.8) (p=0.02). Midwives were rated better in providing breastfeeding information (4.5±0.8) than for the speed of arrival after a call bell (average grade 4.2±1.0). Respondents were least satisfied with the hygiene (toilet, shower and rooms) and the quality of food (average grades 3.8±1.1 and 3.9±1.0, respectively). Mothers with previous experience in childbirth at the same hospital rated current stay with a similar level of satisfaction. Conclusion Good communication skills of medical and non-medical staff are a recommended step to maintain mothers' childbirth satisfaction, while improvement in quality of nutrition and hygiene should be mandatory.

Introduction Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a biochemical marker significant for early prediction of acute kidney injury in adults. However, it has not been examined sufficiently among the infant population, particularly newborns in terms of reference values. The aim of our study was to determine the concentration of uNGAL in healthy term newborns and to determine if there was a difference in uNGAL concentration according to gender, postnatal age and birth weight. Materials and methods Our study involved 81 healthy term newborns birth (≥ 37 weeks, Apgar score ≥ 8 in the first minute after birth, CRP < 5 mg/L). Urine NGAL was measured using chemiluminescent microparticle immunoassay (CMIA) within 72 hours after birth, on Architect plus ci8200 analyser (Abbott, Chicago, USA). Data were analysed using Statistica software. Results The median concentration of uNGAL in the whole study group of healthy term newborns was 27.1 ng/mL (16.5-56.0 ng/mL) (newborn girls, 27.1 ng/mL (15.8-47.9 ng/mL); newborn boys, 27.9 ng/mL (16.5-61.0 ng/mL), P = 0.941). Median uNGAL concentration according to postnatal age expressed in days was 28.2 ng/mL (11.7-57.2 ng/mL) 1st day, 28.9 ng/mL (16.5-64.2 ng/mL) 2nd day and 23.9 ng/mL (20.2-46.6) 3rd day, P = 0.863. Regarding birth weight for newborns < 3500 g, median concentration was 25.0 ng/mL (16.5-45.4 ng/mL) and for weight ≥ 3500 g 30.6 ng/mL (16.5-64.2 ng/mL), P = 0.455. Conclusions There were no significant difference in uNGAL concentration in relation to gender, postnatal age and birth weight.

In post-war Herzegovina, the health services were significantly devastated and there was a great need for recovery and progress. The Faculty of Medicine was established in 1997 in Mostar. At the same time, in order to raise the level of health care, there was a need to educate nurses and other health workers. In accordance with the Munich Declaration and the Bologna Process, the Governing Board of the University of Mostar adopted a Decision on the establishment of the Health School, which began in October 2000 with the Study of Nursing, with the Study of Physiotherapy in 2001, and with the Study of Radiological Technology in 2002. We tried to make the programs in accordance with the programs of Health Schools in Zagreb, Sarajevo and Maribor, so that students could work in Bosnia and Herzegovina (B&H), Croatia and the European Union after finishing their education in Mostar. Using the experience from the Faculty of Medicine, and the fact that most of the subjects were taught by visiting professors from Sarajevo, Zagreb, Split and Osijek, we introduced classes in shifts from the beginning, ie block teaching, which allows continuous learning. In addition to the three-year professional Study of Nursing, in 2003 the four-year university Study of Nursing also began. Since 2005, students in all studies have been enrolling in undergraduate university studies according to a new curriculum adapted to the Bologna Process. The Study of Sanitary Engineering and the Study of Midwifery were established in 2011 and 2014, respectively. The new building of the Faculty of Health Studies (FZS) on Bijeli brijeg, with modern space and equipment, which, along with the Faculty of Medicine and the University Clinical Hospital, makes up a modern biomedical center in Mostar, was completed in 2009 (Šimi 2016). In addition to being the most numerous and important health professionals, nurses and technicians form a key link in the fight for human health in the world. According to the statistics of the World Health Organization, in the health care of most countries, nurses and midwives make up about 80% of qualified medical staff, and are involved in all life stages of human life. In fact, as much as they are numerical as professional, they are a powerful force that is introducing the changes needed to achieve the goal of ‘health for all people’ in the 21 century. Their scope of work covers a wide range of health services and is the foundation on which more or less most medical teams are based. They work in teams from prevention, enlightenment to the last phase of human life. In the territory of Bosnia and Herzegovina, the combination of previous experiences with new achievements of the European Union is necessary, and this is done by the Faculty of Health Studies of the University of Mostar. Medical science is advancing more and more day by day, which means that doctors are constantly discovering new knowledge, entering previously unknown spheres. Therefore, what is foreseeable and what is already happening, is that the medical profession leaves certain activities to nurses and technicians (Lon ar 2017). In the process of continuous struggle for health, prevention and treatment, the role of a highly educated health worker is becoming increasingly important and he is certainly becoming an irreplaceable link in the process. The goal of our faculty is to educate the best possible health workers who, in addition to quality practical work, will gradually take over our teaching (Babi et al. 2017).