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.

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 determine whether immunohistochemical B7-H3 expression is associated with magnetic resonance imaging (MRI)-derived tumour volume, peritumoral brain oedema volume, and oedema index in adult gliomas. METHODS This retrospective radiopathological correlation study included 99 consecutive patients with histopathologically confirmed intracranial gliomas surgically treated between 2013 and 2021. B7-H3 expression (clone RBT-B7H3, Bio SB, USA) was evaluated using staining intensity, percentage of positive tumour cells, and a composite immunoreactive score (IRS). Tumour volume (TV), peritumoral brain oedema volume (PTBE), and oedema index (EI) were calculated from orthogonal MRI measurements. Spearman correlation and crude and adjusted linear regression were used. Adjusted models included age, sex, tumour grade, and Ki-67. RESULTS Median TV was 29.31 cm3 (IQR 12.17-49.12), median PTBE was 84.51 cm3 (IQR 47.59-178.18), and median EI was 4.56 (IQR 3.83-5.00). B7-H3 IRS correlated strongly with TV (r = 0.921, p < 0.001) and PTBE (r = 0.920, p < 0.001), but not with EI (r = -0.105, p = 0.299). After adjustment, B7-H3 IRS remained associated with ln(TV) (beta = 0.228, 95% CI 0.190-0.265, p < 0.001) and ln(PTBE) (beta = 0.178, 95% CI 0.152-0.204, p < 0.001), but not with EI (beta = 0.001, 95% CI -0.083 to 0.084, p = 0.990). CONCLUSION B7-H3 expression is independently associated with MRI-derived tumour volume and peritumoral brain oedema volume in adult gliomas, but not with oedema index, supporting its relationship with absolute MRI-visible lesion burden.

OBJECTIVE To investigate reported paper mill involvement among retracted systematic reviews and meta-analyses (SR/MAs), and to compare retracted SR/MAs with and without reported paper mill involvement with respect to temporal patterns, disciplinary profile, country recorded in the database, and retraction characteristics. STUDY DESIGN AND SETTING Cross-sectional study based on the Retraction Watch database. Records were screened to identify retracted SR/MAs. Reported paper mill involvement was assigned only when explicitly stated in the Retraction Watch record or associated retraction information; fake peer review was coded separately. Group comparisons used the Pearson chi-square and Mann-Whitney U tests. Associations with reported paper mill involvement were estimated using univariable Poisson regression with robust variance and reported as prevalence ratios (PRs) with 95% confidence intervals (CIs). These analyses were treated as exploratory, non-inferential internal contrasts within the dataset of already retracted SR/MAs. RESULTS Among 69,163 retracted publications in the Retraction Watch dataset, 1,071 (1.5%) were identified as retracted SR/MAs. Of those, 191 (17.8%) were paper mill-associated and 880 (82.2%) were not. In the database country field, China was recorded for 732/1,071 retracted SR/MAs (68.3%) and 177/191 SR/MAs with reported paper mill involvement (92.7%). The annual number of paper mill-associated SR/MAs peaked in 2023 (n=152). Within this restricted dataset, paper mill-associated SR/MAs had a longer median time to retraction (511 vs 459 days; p=0.024), more frequent results-related concerns (89.0% vs 30.0%), data issues (53.4% vs 17.5%), referencing concerns (53.9% vs 13.6%), and ethical concerns (8.9% vs 2.6%) (all p<0.001), and less frequent multi-country authorship (8.9% vs 17.6%; p=0.004). In univariable Poisson regression analyses restricted to retracted SR/MAs, larger observed proportions of reported paper mill involvement were seen among records linked to China in the database country field (PR 5.86, 95% CI 3.45-9.93), more recent publication years (PR 1.20 per 1-year increase, 95% CI 1.16-1.23), the medical broad domain (PR 3.66, 95% CI 1.66-8.08), and records with results-related concerns (PR 11.88, 95% CI 7.68-18.39). These PRs should not be interpreted as likelihoods, risks, or rates beyond the analyzed Retraction Watch subset. CONCLUSION In this Retraction Watch-based analysis, reported paper mill involvement was identified in 191/1,071 retracted SR/MAs (17.8%). These records were most often linked to China in the database country field (177/191; 92.7%) and clustered in recent years, particularly 2023. These findings should be interpreted as descriptive patterns within detected and retracted records, not as country-level rates, comparative performance indicators, or estimates of the true prevalence of paper mill activity.

BACKGROUND Acute hyperglycemia is frequently observed in patients presenting with acute coronary syndromes and is considered a marker of metabolic and neurohormonal stress. However, its prognostic significance relative to chronic glycemic status remains incompletely understood, particularly in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Glycated hemoglobin (HbA1c) reflects long-term glycemic control but may not adequately capture acute metabolic derangements occurring during myocardial ischemia. Stress hyperglycemia reflects a transient metabolic response to acute illness mediated by counter-regulatory hormones, systemic inflammation, and increased hepatic gluconeogenesis, and does not necessarily indicate pre-existing insulin resistance or chronic dysglycemia. Recent studies suggest that stress-related hyperglycemia indices may better reflect short-term risk, yet comparative data in NSTEMI populations remain limited. AIM To determine whether admission stress hyperglycemia indices are associated with early mortality in patients with non-ST elevation myocardial infarction. METHODS This prospective, single-center observational study consecutively enrolled 171 patients admitted with confirmed NSTEMI. Stress hyperglycemia was assessed using the stress hyperglycemia ratio (SHR) and the admission glucose-to-chronic glycemia ratio (ACGR), calculated from admission plasma glucose and HbA1c values obtained at hospital presentation. Patients were categorized according to established HbA1c thresholds. Clinical, laboratory, and echocardiographic data were systematically collected. All patients were followed for three months after discharge. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, or urgent coronary revascularization. The secondary endpoint was all-cause mortality. Discriminatory performance was evaluated using receiver operating characteristic (ROC) curve analysis. Multivariable logistic regression models were constructed to assess the independent and incremental prognostic value of stress hyperglycemia indices before and after adjustment for established clinical and echocardiographic predictors. RESULTS During the three-month follow-up period, 88 MACE and 25 deaths were recorded. HbA1c categories were not significantly associated with all-cause mortality or MACE. In contrast, admission glucose levels, SHR, and ACGR were significantly higher in non-survivors than in survivors. No significant differences in HbA1c were observed between outcome groups. Stress hyperglycemia indices demonstrated modest discriminatory ability for predicting mortality and showed greater discrimination than HbA1c in ROC analyses. In multivariable models, both SHR and ACGR remained independently associated with early mortality after adjustment for demographic, clinical, and echocardiographic variables, whereas no independent association with the composite MACE endpoint was observed. ROC-derived thresholds used for survival analyses were exploratory and have not been externally validated. CONCLUSION In patients with NSTEMI, stress hyperglycemia indices assessed at hospital admission are independently associated with early mortality, whereas chronic glycemic status shows limited prognostic relevance. These indices appear to reflect acute systemic stress and metabolic instability and may provide clinically useful information for early risk stratification during the initial phase of hospitalization, particularly when comprehensive echocardiographic assessment is not yet available.

OBJECTIVES Transsphenoidal surgery for the resection of pituitary neoplasms has evolved over the years. The current study sought to summarize visual outcomes following transsphenoidal surgery for sellar and parasellar lesions and evaluate how these outcomes are reported across the literature. METHODS A systematic review was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, Scopus and Cochrane Library database were searched from inception through October 2023. Studies were included if they reported pre- and post-operative visual outcomes for patients undergoing transsphenoidal resection of sellar or parasellar lesions. Reviews, abstracts, and non-English studies were excluded. Rates of pre- and postoperative visual loss, visual field defects, and visual acuity impairment were collected. Postoperative outcomes were categorized as improved, normalized, unchanged, or worsened. RESULTS Of 3828 studies identified, 236 met inclusion criteria and were included in the analysis. Pituitary adenomas accounted for 80% of cases, followed by craniopharyngiomas (14%) and meningiomas (4%). Preoperative visual loss, visual field defects, and visual acuity impairment were present in 55%, 51%, and 37% of patients, respectively. Postoperative improvement occurred in 76% of patients with visual loss, 73% with visual field defects, and 64% with visual acuity impairment, while 2%-11% experienced worsening of symptoms. Reporting completeness varied across studies, with fewer than half of studies reporting both pre- and post-operative outcomes. CONCLUSIONS Across all studies, approximately 76% of patients with preoperative visual impairment experienced postoperative improvement following transsphenoidal surgery. Reporting of visual outcomes remains highly variable, underscoring the need or standardized definitions and outcome measures in future research.

This systematic review analyzed treatment strategies and outcomes for spinal low-grade gliomas, based on data from 63 studies encompassing 954 patients. Surgery was the primary treatment, with gross total or subtotal resection associated with improved survival. Subtotal resection followed by radiotherapy prolonged progression-free survival. Fractionated radiotherapy (45-50 Gy) showed disease stabilization and neurologic improvement, with some studies reporting a 5 year progression-free survival of 93% and an overall survival of 100%. Chemotherapy was mainly used in recurrent cases. Prognosis varied by histology; pilocytic astrocytomas showed excellent survival, while infiltrative gliomas were linked to poorer long-term outcomes.

This response to the letter expands the discussion on the evolving demands of peer review for systematic reviews and meta-analyses. We emphasize that the main concern surrounding artificial intelligence is not its limited and disclosed use for language support, but undisclosed application and insufficient human verification, which may compromise citation accuracy, interpretation, and overall trustworthiness. We also argue that similarity reports should be interpreted contextually, particularly in evidence syntheses where standardized methodological language is unavoidable, and that low similarity does not necessarily exclude manuscript manipulation. Finally, we highlight reference verification as a central research-integrity challenge that should not rest on peer reviewers alone. Preserving the credibility of evidence synthesis requires shared responsibility across authors, reviewers, editors, and publishers.

BACKGROUND Hyponatremia is a common postoperative electrolyte disturbance in neurosurgical patients and may present with nonspecific neurocognitive symptoms that overlap with intracranial complications. Carbamazepine (CBZ), frequently used for seizure prophylaxis and pain syndromes, is a recognized cause of drug-induced hyponatremia with a syndrome of inappropriate antidiuretic hormone secretion (SIADH)-like profile. CASE SUMMARY A 62-year-old woman underwent elective left supraorbital craniotomy and microsurgical resection of a left anterior skull-base meningioma. Postoperatively, CBZ 400 mg was initiated twice daily for antiseizure prophylaxis. On postoperative day (POD) 2, she developed somnolence and cognitive slowing with serum sodium 131 mmol/L, which progressed to 123 mmol/L (POD 3) and 119 mmol/L (POD 7) despite isotonic saline and increased dietary sodium. Hypertonic saline (3% NaCl) was introduced with partial correction. Evaluation confirmed hypotonic hyponatremia (serum osmolality 254 mOsm/kg) with inappropriately concentrated urine (urine osmolality 560 mOsm/kg) and elevated urine sodium (68 mmol/L) in a clinically euvolemic patient; thyroid and adrenal functions were normal. Given the temporal association and SIADH-like pathophysiology, CBZ-induced hyponatremia was considered the most likely etiology. CBZ was discontinued and replaced with levetiracetam (titrated to 500 mg twice daily), followed by clinical improvement and steady sodium normalization (132 mmol/L at discharge; 136 mmol/L by POD 19), remaining normal at three-month follow-up. We searched PubMed and Google Scholar to for relevant literature review. CONCLUSION This case highlights CBZ as a potentially reversible cause of significant postoperative hyponatremia after meningioma surgery. Early sodium monitoring after CBZ initiation and prompt substitution with alternative antiseizure therapy should be considered when euvolemic hypotonic hyponatremia develops in the postoperative period.

Background/Objectives: Cardiorenal syndrome type 2 (CRS-2) is characterized by progressive renal dysfunction caused by chronic heart failure (HF) and is associated with increased morbidity and mortality. However, the prognostic value of renal biomarkers in patients with CRS-2 hospitalized for decompensated HF remains unclear. Methods: This prospective observational cohort study included 200 consecutive patients hospitalized for decompensated HF in the Intensive Care Unit of the Clinic for Internal Medicine at the University Clinical Centre Tuzla between April and October 2025. CRS-2 was defined as chronic HF with chronic kidney disease persisting for ≥3 months before admission according to KDIGO criteria. Patients were followed for three months. The primary composite outcome was all-cause mortality or initiation of renal replacement therapy. Results: CRS-2 was identified in 130 patients (65.0%) and was associated with higher in-hospital mortality (32.3% vs. 11.4%, p = 0.002) and three-month mortality (44.6% vs. 21.4%, p = 0.002). Within the CRS-2 subgroup, patients who experienced the primary composite outcome had higher admission levels of cystatin C and urinary albumin-to-creatinine ratio (UACR) and lower estimated glomerular filtration rate (eGFR). ROC analysis demonstrated moderate discriminative ability of cystatin C (AUC 0.739) and UACR (AUC 0.733). In Cox regression analysis, cystatin C (HR 1.534, 95% CI 1.263–1.863, p < 0.001) and UACR (HR 1.003, 95% CI 1.001–1.006, p = 0.001) were significantly associated with the primary composite outcome. Conclusions: Renal dysfunction markers, particularly cystatin C and albuminuria, are associated with early adverse outcomes in CRS-2 patients hospitalized for decompensated HF. Routine assessment of these biomarkers may provide additional prognostic information and support risk assessment in this high-risk population.

AIM To identify predictors of all-cause mortality and 6-month rehospitalisation in patients with hypertensive crisis, focusing on inflammatory indices, metabolic markers measured at admission, and antihypertensive treatment profiles. METHODS This prospective observational study included 210 adult patients with hypertensive crisis. Demographic, clinical, and therapeutic data were collected, including data on comorbidities, antihypertensive drug use, and treatment adherence. Laboratory parameters obtained at admission included neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), homocysteine, and uric acid. Patients were followed for 12 months. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to identify independent predictors. RESULTS Mortality occurred in 10.9% of patients, and 27.1% were rehospitalised within 6 months. Deceased patients exhibited significantly higher levels of PLR (p=0.0329), SII (p=0.0355), homocysteine (p=0.0488), and uric acid (p=0.021). In multivariate analysis, homocysteine (OR=3.55; p<0.001), uric acid (OR=1.03; p=0.007), PLR (OR=1.04; p=0.047), and SII (OR=1.01; p=0.030) remained independently associated with mortality. Chronic kidney disease (OR=2.15, p=0.012) and poor treatment adherence (OR=1.92; p=0.017) were also significant predictors. ROC analysis demonstrated moderate discriminative power, with AUC values of 0.68 for PLR, 0.66 for SII, 0.65 for homocysteine, and 0.63 for uric acid. CONCLUSION Elevated inflammatory indices and metabolic markers, particularly homocysteine and uric acid, were independently associated with increased mortality risk. Additionally, chronic kidney disease and suboptimal adherence to antihypertensive therapy significantly contributed to adverse outcomes. These findings underscore the importance of comprehensive risk assessment and personalised management in this high-risk population.

BACKGROUND Inflammation-driven mechanisms play a central role in adverse outcomes after non-ST-elevation myocardial infarction (NSTEMI), yet simple, widely available biomarkers for early risk stratification remain insufficiently defined. Hemogram-derived indices and iron-related inflammatory markers may provide complementary prognostic information. OBJECTIVE To evaluate the prognostic significance of the mean platelet volume-to-monocyte ratio (MMR) and serum ferritin in predicting major adverse cardiovascular events (MACE) in patients with NSTEMI, and to assess the association of angiotensin-converting enzyme (ACE) inhibitor therapy with clinical outcomes. METHODS This prospective cohort study included 170 consecutive NSTEMI patients admitted to the University Clinical Center Tuzla between February 2022 and January 2023. All patients received dual antiplatelet therapy and high-intensity statins. The baseline evaluation included a complete blood count, serum ferritin, and C-reactive protein. MMR was calculated as the ratio of mean platelet volume to absolute monocyte count. Patients were followed for 12 months for the occurrence of MACE, defined as cardiovascular death, non-fatal myocardial infarction, urgent revascularization, stroke, or hospitalization for heart failure. RESULTS During follow-up, 103 patients (60.6%) experienced MACE. Admission MMR (18.1 ± 11.7 vs 13.2 ± 5.5; P = 0.003) and ferritin levels (284 ± 396 vs 152 ± 109 µg/L; P = 0.001) were significantly higher in patients with events. In multivariable analysis, both MMR (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02-1.11; P = 0.008) and ferritin (OR 1.28 per 100 µg/L, 95% CI 1.10-1.55; P = 0.003) independently predicted MACE, while ACE inhibitor therapy was associated with a lower risk (OR 0.24, 95% CI 0.08-0.70; P = 0.01). The combined model demonstrated good discriminative performance (AUC 0.72; 95% CI 0.64-0.80). CONCLUSION AND RELEVANCE Elevated admission MMR and ferritin were independently associated with a higher 1-year risk of MACE in patients with NSTEMI. ACE inhibitor therapy was associated with improved outcomes, although causality cannot be inferred. These findings suggest that readily available inflammatory biomarkers may complement established clinical parameters for early risk stratification and support continued guideline-directed pharmacotherapy in NSTEMI.

Aim: To identify the clinicopathological factors associated with five year mortality in patients with colorectal cancer (CRC) treated at Cantonal Hospital Zenica, Bosnia and Herzegovina. Methods: A retrospective cohort of 64 consecutively operated CRC patients (2019 2024) was analysed. The base-line variables included age, sex, tumor stage, histology, metastatic burden, local infiltration, and comorbidities. Five year cumulative mortality was the primary outcome. Risk ratios (RR) with 95 % confidence intervals (CI) were calculated by two by two contingency analysis.Results: The cohort comprised 26 women (40.6 %) and 38 men (59.4 %); their median age was 64 years (IQR 58.8–73.0). Eleven patients (17.2 %) died within five years. Mortality was strongly linked to tumor spread and cardiometabolic disease. Any distant metastasis conferred a fifteen fold increase in risk (9/15 vs 2/49; RR 14.7, 95 % CI 3.6–60.8, p < 0.001), and the involvement of two or more metastatic sites remained prognostic (RR 5.6, 95 % CI 1.9–16.9,p = 0.014). Infiltration of more than two adjacent organs quadrupled mortality (RR 4.4, 95 % CI 1.7–11.6, p = 0.032). Hypertension was present in 10 of the 11 deaths, yielding an RR of 12.1 (95 % CI 1.6–88.8, p = 0.002).Type 2 diabetes also increased risk (RR 3.5, 95 % CI 1.3–9.6, p = 0.040). Patients with three or more comorbid conditions had a nearly four times higher mortality (RR 3.9, 95 % CI 1.3–11.7, p = 0.027).Conclusion: The five year death rate in this Bosnian Herzegovinian CRC cohort was driven chiefly by distant metastasis, extensive local invasion, and cardiometabolic comorbidities—especially hypertension and type 2 diabetes. Early detection of metastatic spread and proactive management of vascular risk factors may improve survival in similar settings.

Symptomatic Meckel’s diverticulum (MD) has various clinical presentations and can be easily misdiagnosed. This multicenter study examines the clinical characteristics, management, and outcomes of patients across five academic pediatric surgery centers in Bosnia & Herzegovina and Serbia. We retrospectively included all pediatric patients (< 18 years) who were surgically and histopathologically confirmed to have symptomatic MD between 2011 and 2020. Demographics, clinical and radiological features, surgical treatment approaches, histopathologic findings, and outcomes were collected and analyzed. Among 151 patients (80.1% male), the median age was 6.7 years (IQR 1.5–10.8). Presentations included intestinal obstruction (38.4%), GI bleeding (37.8%), and peritonitis (23.8%); 63.6% had multiple symptoms. A technetium-99 m scan was positive in 80.7% of bleeding cases. Laparotomy was performed in 72.2%, laparoscopy in 23.2%, and conversion in 4.6%. Partial small bowel resection was required in 80.8%, versus diverticulectomy in 19.2% (p < 0.001). Ectopic mucosa was found in 55.6% (gastric 48.3%, pancreatic 2.6%, both 4.6%; p = 0.05), significantly more common in males (p < 0.001). Postoperative complications occurred in 3.2%, with no mortality. Symptomatic MD displays highly variable clinical presentations. It is often underdiagnosed preoperatively, particularly without GI bleeding, emphasizing the need for high clinical suspicion and tailored surgical approaches.