BACKGROUND Non-ST segment elevation myocardial infarction (NSTEMI) poses significant challenges in clinical management due to its diverse outcomes. Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care. AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events (MACE) in NSTEMI patients, potentially improving clinical outcomes. METHODS A prospective, observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla, Bosnia and Herzegovina. The study included 170 patients with NSTEMI, who were divided into a group with MACE and a control group without MACE. Furthermore, the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis. Alongside hematological parameters, an additional 13 hematological-derived ratios (HDRs) were monitored, and their prognostic role was investigated. RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction (NSTEMI) patients with MACE and a control group at T1 and T2. However, significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE. Notably, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were elevated in lethal outcomes. Furthermore, C-reactive protein-to-lymphocyte ratio (CRP/Ly) at T1 (> 4.737) demonstrated predictive value [odds ratio (OR): 3.690, P = 0.024]. Both NLR at T1 (> 4.076) and T2 (> 4.667) emerged as significant predictors, with NLR at T2 exhibiting the highest diagnostic performance, as indicated by an area under the curve of 0.811 (95%CI: 0.727-0.859) and OR of 4.915 (95%CI: 1.917-12.602, P = 0.001), emphasizing its important role as a prognostic marker. CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients. During follow-up, NLR, PLR, and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.

<p><strong>Aim</strong> Acute kidney injury (AKI) presents a high mortality complication in patients with acute myocardial infarction (AMI). Yet, its correlation with non-ST elevation myocardial infarction (NSTEMI) remains neglected in the literature. This study aims to investigate the prevalence, risk factors, clinical features, and short-term outcomes associated with AKI development in patients with acute NSTEMI.<br /><strong>Methods</strong> A one-year prospective observational cohort study involved 170 consecutive patients hospitalized in the Intensive Care Department of the Internal Medicine Clinic at the University Clinical Centre Tuzla diagnosed with acute NSTEMI. Patients were subsequently categorized into AKI and non-AKI groups based on AKI development within 48 hours. Demographic characteristics, laboratory findings, and short-term clinical outcomes were compared between the groups.<br /><strong>Results</strong> Of 170 patients, 31 (18.2%) developed AKI within 48 hours of acute NSTEMI. Significant age differences, blood urea nitrogen (BUN), creatinine, estimated glomerular filtration rate (eGFR), blood glucose level (BGL), C-reactive protein (CRP), and high sensitivity (hs) troponin were observed, making patients with lower baseline kidney function, more extensive myocardial infarction, and a heavier systemic inflammatory response following acute NSTEMI more susceptible to AKI development. In the follow-up period, mortality rates were significantly higher in the AKI group, amounting to 35.5% compared to 10.1% in the non-AKI group. Additionally, mortality increased with the severity of AKI, reaching 100% in AKI stage 2.<br /><strong>Conclusion</strong> This study highlights demographic, clinical and laboratory findings in patients with acute NSTEMI, which contribute to AKI development. Early detection and tailored interventions are crucial in mitigating AKI-associated morbidity and mortality.</p>

<p><strong>Aim</strong> To investigate the predictors of biochemical relapse (BCR) among patients with non-metastatic prostate cancer treated with radiotherapy as the first-line therapy.&nbsp;<br /><strong>Methods</strong> The study included 91 patients diagnosed with prostate cancer at the University Clinical Centre in Tuzla, Bosnia and Herzegovina. After the radiation treatment as the first line of treatment, the patients were monitored for the next 36 months. If patients were classified in medium and high-risk groups, hormone therapy was administered. The occurrence of BCR was determined based on prostate-specific antigen (PSA) values. Potential prognostic parameters, including Gleason score (GS), PSA, tumour size (TNM), and standardised risk classification (RC), were monitored.<br /><strong>Results</strong> A total of 46 (50.5%) patients were aged 66-75, with a median PSA of 14.50 ng/mL. A Gleason score &lt;6 was found in 72 (79.1%) of patients, and 31 (34.1%) had T2c tumours. The BCR occurred in 32 (35.2%) patients, with a median relapse time of 18 months. Significant predictors of BCR were Gleason score &ge;6 (OR:4.46; p=0.006) and tumour stage &gt;T2b (OR:3.59; p=0.021). The RC showed an Area Under Curve (AUC) of 0.634 (p=0.050), indicating its potential diagnostic accuracy.<br /><strong>Conclusion</strong> Gleason score &ge;6 and TNM&gt;T2b are significant predictors of biochemical relapse in prostate cancer patients treated with radiotherapy. These results emphasize the need for additional monitoring and timely treatment of clinical disease progression in patients with Gleason score &ge;6 and tumour stage &gt;T2b.</p>

<p><strong>Aim</strong> To compare the impact of electrical cardioversion (ECV) and pharmacological cardioversion (PCV) on left atrial size (LA) and left ventricular ejection fraction (LVEF), as well as to identify predictors of rhythm disorder recurrence in patients with atrial fibrillation (AF) or atrial flutter (AFL).<br /><strong>Methods</strong> A prospective observational cohort study was conducted on 105 patients with persistent AF or AFL at the University Clinical Centre Tuzla. The patients were divided into two groups: 53 underwent ECV and 52 received PCV. Demographic and clinical data, including ECG and transthoracic echocardiography, were collected. Follow-up assessments were conducted at 7 days, 1 month, and subsequently every 3 months for a year.<br /><strong>Results</strong> Baseline characteristics were similar between the groups. Recurrence of rhythm disorder within one year was observed in 52.4% of cases, with ECV showing a slightly lower, though not significantly different, primary failure rate at 7 days compared to PCV (13.2% vs. 23.1%). Significant predictors of recurrence included longer duration of disorder (p&lt;0.001), hypertension (p=0.016), lack of pre-cardioversion amiodarone (p=0.027), and larger LA (p&lt;0.001). Both ECV and PCV significantly reduced LA over time, with no significant differences in LVEF between groups.<br /><strong>Conclusion</strong> Both ECV and PCV are effective in restoring sinus rhythm, with a trend towards lower recurrence in the ECV group. Predictors such as disorder duration, hypertension, lack of pre-cardioversion amiodarone, and LA should be considered when planning cardioversion to optimize patient outcomes.</p>

<p><strong>Aim</strong> To investigate clinical and morphometric characteristics of patients with lower urinary tract symptoms (LUTS) due to lumbar spinal stenosis (LSS).<br /><strong>Methods</strong> This study evaluated LSS patients using clinical assessments of motor, sensory, bladder, and bowel functions, and functional disability scores from the Oswestry Disability Index (ODI) and Swiss Spinal Stenosis Questionnaire (SSSQ). Morphometric analysis included MRI measurements of the anteroposterior diameter of the intervertebral disc and dural sac, and the modified Torg-Pavlov ratio (mTPR), with follow-up re-evaluations at 6 months.<br /><strong>Results</strong> Of 159 patients, 49 (30.8%) had LUTS and 110 (69.2%) were in the control group. LUTS patients had a significantly higher prevalence of neurogenic claudication (100% vs. 47.3%; p&lt;0.001), lower back pain (93.9% vs. 77.3%; p=0.011), and lower extremity pain (57.1% vs. 34.5%; p=0.008). The LUTS group also had higher ODI (54.0 vs. 50.0; p=0.019) and SSSQ score (44.0 vs. 34.0; p&lt;0.001). Morphometric analysis showed significantly lower mTPR in LUTS patients (median 0.31 vs. 0.45; p&lt;0.001), with an AUC of 0.704 (95%CI 0.627-0.774). mTPR&le;0.31 predicted surgical revision within 6 months (OR:3.4, CI: 1.2-9.8), motor deficiency (OR:2.1, 95%CI: 1.4-5.2), and persistent LUTS post-surgery (OR:4.5, 95%CI: 1.1-18.9). mTPR&le;0.34 was associated with worse follow-up outcome, including increased ODI (&beta;:3.2; 95%CI: 1.1-5.3; p=0.004) and SSSQ score (&beta;:4.8; 95%CI:2.1-7.5).<br /><strong>Conclusion</strong> LUTS patients with LSS exhibit more severe symptoms and poorer outcome, with mTPR&le;0.34 being a predictor of adverse clinical outcome and the need for surgical revision within 6 months.</p>

Background Acute pancreatitis (AP) is a condition with various etiological factors, marked by the sudden onset of inflammation in the pancreatic tissue. Predicting the severity and potential mortality of AP involves analyzing clinical data alongside laboratory tests and imaging. Among several grading methods with strong predictive capabilities for illness severity and mortality, the Bedside Index for Severity in Acute Pancreatitis (BISAP) score is notable. This study aims to explore the potential role of laboratory markers, specifically red cell distribution width (RDW), RDW/platelet (PLT) ratio, and mean platelet volume (MPV), in predicting disease severity, with patients being stratified according to the BISAP scoring system. Materials and methods This research included 161 patients hospitalized at Cantonal Hospital Zenica in Zenica, Bosnia and Herzegovina, with a diagnosis of AP. The BISAP score was determined based on laboratory and radiological analyses. This score was used to evaluate potential correlations between laboratory findings such as RDW, RDW/PLT ratio, and MPV. Results The age range was significantly higher in patients with BISAP scores ≥3 (68 years, 64-76) compared to those with BISAP scores <3 (59.5 years, 42.75-69) (p = 0.000). RDW values were also significantly higher in patients with BISAP scores ≥3 (15.6%, 14-16.9) compared to those with BISAP scores <3 (13.5%, 13-14.1) (p = 0.000). Hospital stay duration was significantly longer for patients with BISAP scores ≥3 (9 days, 6-11) compared to those with BISAP scores <3 (5 days, 5-7) (p = 0.000). Additionally, the RDW/PLT ratio was significantly lower in patients with BISAP scores <3 (0.063 ± 0.02) compared to those with BISAP scores ≥3 (0.09 ± 0.059) (p = 0.012). Conclusion Our results indicate a significant difference in RDW/PLT ratios between patient severity groups based on BISAP scores (scores <3 vs. ≥3). This suggests that the RDW/PLT ratio may serve as a useful predictor for assessing the severity of AP. However, further research is needed to explore the full potential of the RDW/PLT ratio in evaluating AP patients.

Bosnia and Herzegovina (BiH) accumulates challenges in the areas of research and innovation (R&I), agricultural water management (AWM) and their intersection. In the decade 2012–2022, the BiH gross domestic product per capita in current US$ increased by 6.2% annually. However, improvements are slowly arriving in R&I and AWM. In this period, relevant challenges to AWM have materialized, such as climate change effects or the need to implement an interconnected vision of ecosystem services. In the R&I arena, the societal demand for knowledge goods remains low, while the reforms of higher education and R&I funding systems have become urgent. This paper set out to elaborate a realistic and feasible policy roadmap to consolidate R&I in AWM in BiH. The methodology included an assessment of policies and sector performance, the analysis of stakeholder perceptions, the development of strategic directions and the design of a strategy. Desk research and stakeholder consultations (33 interviews, six workshops, 179 persons in total) were used to take stock of the current situation and expectations for the future. Stakeholders were divided into knowledge supply and knowledge demand, with five and six subcategories, respectively. Relations were established among the key enabling factors, the needs and the capacities of the involved stakeholders. The TOWS (Threats, Opportunities, Weaknesses and Strengths) matrix permitted to identify policy strategies. A Weaknesses – Opportunities, conservative or mini-maxi strategy was selected, owing to the relevance of system weaknesses (such as low investments, poor return of R&I to society or low R&I for AWM adaptation) and opportunities (such as the Green Agenda for the Western Balkans, Smart Specialization or regional partnerships). The policy roadmap was structured along three policy goals: strengthen R&I, strengthen AWM and identify / fund local R&I priorities for AWM. Policy goals included policy instruments promoting eco-efficient use of resources and sustainable development of rural areas.

Aim To examine safety and efficiency of electrocardioversion (EC) in elective treatment of atrial fibrillation and atrial flutter in the setting of Day Hospital by determining success rate, frequency of adverse events and possible cost benefit compared to admitting a patient into hospital. Methods This prospective observational cohort study was performed in Day Hospital and in Intensive Care Department of Internal Medicine Clinic, University Clinical Centre Tuzla from January 2019 to December 2022 and included 98 patients with a persistent form of atrial fibrillation (AF) or atrial flutter. The patients who were divided in two groups, 56 hospitalized and 42 patients accessed in Day Hospital. In all patients, medical history, physical examination, electrocardiogram (ECG) and transthoracic echocardiogram (TTE) evaluation was performed in addition to laboratory findings. Electrocardioversion was performed with a monophasic General Electric defibrillator in anterolateral electrode position with up to three repetitive shocks. Results In hospital setting group overall succes rate of electrocardioversion was 85%, with average 2.1 EC attemps, there was with one fatal outcome due to stroke, one case of ventricular fibrillation (VF) due to human error, and 6 minor adverse events; with average cost of was 1408.70 KM (720.23 €) per patient. In Day Hospital setting succes rate was 88%, with average 2 EC attempts, no major adverse events, 8 minor adverse events; and average cost was of 127.23 KM (65.05 €) per patient. Conclusion Performing elective electrocardioversion in Day Hospital setting is as safe as admitting patients into hospital but substantially more cost effective.

The current study aimed to explore whether the level of decrease in platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and mean platelet volume (MPV) has prognostic value for major adverse cardiovascular events (MACEs) in acute myocardial infarction without ST-segment elevation (NSTEMI) treated with clopidogrel. In this prospective observational cohort study, PDW, P-LCR, and MPV were determined on admission at the hospital and 24 h after clopidogrel treatment in 170 non-STEMI patients. MACEs were assessed over a one-year follow-up period. Using the Cox regression test, a decrease in PDW showed a significant association with the incidence of MACEs (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.66–0.99, p ═ 0.049) and overall survival rate (OR 0.95, 95% CI ═ 0.91–0.99, p ═ 0.016). Patients with a decrease in PDW<9.9% had a higher incidence of MACEs (OR 0.42, 95% CI ═ 0.24–0.72, p ═ 0.002) and a lower survival rate (OR 0.32, 95% CI ═ 0.12–0.90, p ═ 0.03) than patients who had a decrease in PDW<9.9%. In the Kaplan–Meier analysis using log-rank test, patients who had a decrease in PDW<9.9% had an increased risk for MACEs (p ═ 0.002) and lethal outcomes (p ═ 0.002). However, a decrease in MPV or P-LCR did not have prognostic value. A decrease in PDW<9.9% measured 24 h after clopidogrel treatment in NSTEMI patients has good prognostic value for determining the short-term risks of MACEs, possibly providing a better risk stratification of those patients.

The highest quality silage is produced from corn (corn silage), which is also the most common livestock feed. The lack of corn silage in livestock production can be compensated only by concentrated feed, which is usually more expensive, but this is a wellapplied practice in B&H. Therefore, the main aim of this paper was to determine the economic viability of corn silage production in B&H for the period 2014-2019. Primary data for this research were collected based on a semi-structured interview with representatives of the farm "Farma Spreča" Kalesija with a total harvested area of 500 ha. Results indicate that with total harvested area increases 61.29 %, yield increases only 6.26 %, while efficiency decreased by 6.38 % implying problems related to productivity. Based on that, corn silage production in B&H shows positive financial performances, but low yield even with a strong increase in harvested areas indicates the need for further technological and technical improvement.

Aim To determine stereological structural parameters of the parenchymal part of the placenta, placental weight and volume of adolescent pregnant women and their correlation with newborns' birth weight. Methods This prospective study was conducted on a total of 60 human placentas of term pregnancy, divided into two groups according to the age of pregnant women. Experimental group consisted of 30 placentas of pregnant women aged 13-19 years. Control group consisted of 30 placentas of pregnant women aged 20-35 years. Stereological analysis was performed. Results Volumetric density of terminal villi of adolescent placentas was significantly higher than the one of control group (p <0.0001). The volumetric density of fibrinoid of adolescent placentas was significantly lower than of the control group (p <0.0001). Total volume of terminal villi of adolescent placentas was significantly higher than of the control group (p<0.0001). The total volume of fibrinoid of adolescent placentas was significantly lower than of the control group (p<0.0001). Newborns of adolescent pregnancies had in average lower birth weight of 439.01 g compared to the newborns of the control group (p <0.00001). Conclusion Adolescent pregnancy affects placental structure, weight and volume. Newborns of adolescent pregnancy have optimal body weight.

A significant number of small farms in Bosnia and Herzegovina (BiH) produce berry fruits. Some of them achieve good economic results, however many have significant potential for further improvement. Due to several beneficial factors, many farms decide for cultivation of a single berry fruit activity, however this decision implies a potential risk in case of unfavourable production or market conditions for that crop. The aim of this analysis is therefore to observe the extent of risk reduction by application of different diversification strategies, using two types of berry fruits; and the most efficient production plans for such a farm from a risk perspective. A linear program was utilized to prepare an optimal production plan, while quadratic risk programming served to analyse risk. Results show that diversification could be a significantly important possibility for risk reduction on such farm type. It is possible to reduce risk with capital and labour less intensive production activities. Production of the highly intensive strawberry variety Clery has highest Estimated Gross Margin (EGM), but is also associated with very high risk. If one includes raspberries or blueberries into the production plan, it is possible to significantly reduce risk while almost keeping EGM at the same level. On the other hand, if the farmer is risk averse, the highest opportunity cost for risk reduction on such a farm type is in production of raspberry and blueberry, where it is necessary to give up 3.25 EUR on average for decreasing risk for one EUR. In the other two scenarios, production of strawberry – blueberry and strawberry – raspberry, risk gradient values are almost the same with amount 2.57 EUR sand 2.56 EUR, respectively.

Title of Days of AMNuBiH 2018” and “SWEP 2018” is “Ethical Dilemmas in Science Editing and Publishing”. Why? If one wants to create a scientific work, must have on his mind that creating a scientific work requires creativity and openness, honesty, trust, and obeying the ethical principles for writing a scientific paper. While working on a an biomedical research involving human subjects medical workers should have on mind that it is the duty of the physician to remain the protector of the life and health of that person on whom biomedical research is being carried out. The World Medical Association (WMA) has developed the Declaration of Helsinki as a statement of ethical principles to provide guidance to physicians and other participants in medical research involving human subjects.

ORcid: Emir Becirovic, http://orcid.org/0000-0002-4134-987X • Ammar Brkic, http://orcid.org/0000-0002-5436-3670 Esad Brkic, http://orcid.org/0000-0002-7784-328X • Amira Kusljugic, http://orcid.org/0000-0003-4537-4615 Edita Sijercic, http://orcid.org/0000-0001-5926-7226 • Hazim Tulumovic, http://orcid.org/0000-0002-0662-5576 Denis Mrsic, http://orcid.org/0000-0002-6736-9561 • Daniela Loncar, http://orcid.org/0000-0001-8186-1766