Aim: The primary aim of the study was to determine the incidence of testicular neoplasms in the Zenica-Doboj Canton (ZDC) region for the period from 2019 to 2021. Also, the study aimed to examine the age structure of the affected population, the frequency of testicular neoplasms in all the ZDC cities and municipalities, and the pathohistological characteristics of neoplasms. Material and methods: The study was conducted at the Oncology and Radiotherapy Department of the Zenica Cantonal Hospital. The study period refers to the time interval from January 2019 to December 2021. The study included 37 patients with a verified diagnosis of testicular neoplasm. Results: Arithmetic mean of patients’ age was 33.49 years, while the standard deviation was 12.59. Most respondents, accounting for 40.5%, were aged 26-35 years. The incidence of testicular neoplasms in the ZDC region was 4.2/100,000 per - sons in 2019, 3.08/100,000 persons in 2020, and 3.10/100,000 persons in 2021. Most diagnosed neoplasms (48.6%) were the myxoid type germ cell originating tumors. Conclusion: The incidence of testicular neoplasms in the ZDC was 4.2/100,000 persons in 2019, 3.08/100,000 persons in 2020, and 3.10/100,000 persons in 2021.

Aim To investigate the correlations between tumour characteristics, symptoms, intraoperative findings, and outcomes in patient with meningioma. Methods A retrospective study was conducted on 86 surgically treated patients at Department of Neurosurgery of Cantonal Hospital Zenica from 2010 to 2020. Patients with intracranial meningiomas underwent neurological evaluation and MRI scans to analyse tumour characteristics, including volume (TV), peritumoral brain oedema (PTBE) and oedema index (EI). Surgical treatment was performed, followed by postoperative MRI and outcome assessment. Intraoperatively, the tumour's relationship with cortex, pial membrane, skull bones, and sinuses was evaluated, and the extent of tumour resection was graded. Meningioma samples underwent histopathological analysis to assess the grade and regularity of borders, and Ki-67 labelling index was determined using immunohistochemistry. Results Significant correlations were found between PTBE and Ki67 expression (p<0.001), PTBE and vomiting/nausea (p=0.002), cognitive impairment (p=0.047), venous compression (p=0.001), cortical, pial and dural invasion (p<0.05), and the postoperative presence of oedema (p=0.002). Venous compression, cortical, pial, dural and bone invasion positively correlated with Ki-67 expression (p<0.001). Grade and tumour border positively correlated with Ki-67 expression (p<0.001). Oedema persistence postoperatively showed a positive correlation with Ki-67 expression (p<0.001). Conclusion The study revealed significant correlations between Ki-67 expression and PTBE, with notable associations with clinical symptoms, tumour characteristics, and postoperative oedema presence.

Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.

Aim This study provides a comprehensive review of the current literature on the use of ChatGPT, a generative Artificial Intelligence (AI) tool, in neurosurgery. The study examines potential benefits and limitations of ChatGPT in neurosurgical practice and education. Methods The study involved a systematic review of the current literature on the use of AI in neurosurgery, with a focus on ChatGPT. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a comprehensive and transparent review process. Thirteen studies met the inclusion criteria and were included in the final analysis. The data extracted from the included studies were analysed and synthesized to provide an overview of the current state of research on the use of ChatGPT in neurosurgery. Results The ChatGPT showed a potential to complement and enhance neurosurgical practice. However, there are risks and limitations associated with its use, including question format limitations, validation challenges, and algorithmic bias. The study highlights the importance of validating machine-generated content for accuracy and addressing ethical concerns associated with AI technologies. The study also identifies potential benefits of ChatGPT, such as providing personalized treatment plans, supporting surgical planning and navigation, and enhancing large data processing efficiency and accuracy. Conclusion The integration of AI technologies into neurosurgery should be approached with caution and careful consideration of ethical and validation issues. Continued research and development of AI tools in neurosurgery can help us further understand their potential benefits and limitations.

Aim To investigate the correlation of body mass index (BMI) with severity of intervertebral disc degeneration. Methods The study enrolled patients who had undergone surgical intervention for a herniated disc at the Department of Neurosurgery of the Cantonal Hospital Zenica. Patients underwent thorough preoperative evaluation, including medical history, neurological and physical assessments, and radiological analysis. The surgical intervention consisted of a posterior lumbar discectomy, and the excised disc material was preserved and subjected to histopathological analysis based on Histopathologic Degeneration Score (HDS). Patients were divided in two groups according to Body Mass Index (BMI): study group with BMI≥25 and control group with BMI<25. Results Among 69 patients with herniated IVD, 26 (37.7%) were with BMI≥25 (study group), and 43 (62.3%) were with BMI<25 (controls). The study group displayed substantial increase in height, 1.80±0.06 m compared to controls, 1.74±0.06 m (p=0.001). Weight and BMI were significantly higher in the study group of patients (weight: 91.60±10.22 vs. 67.37±9.20 kg, BMI: 28±2 vs. 22±2; p<0.001). Differences were confirmed in HDS values in the study group comparing to the control group (p<0.001). The study group exhibited significant differences in chondrocyte proliferation, tears and clefts, granular changes, and mucous degeneration (p<0.05), and positive correlations were found between BMI and these alterations found in the herniated discs (p<0.05). Therefore, HDS showed positive correlations with BMI (R=0.599; p<0.001) and weight (R=0.696; p<0.001). Conclusion The study's findings confirmed that BMI has a significant impact on intervertebral disc degeneration, emphasizing the importance of weight management in preventing disc degeneration.

Appendiceal neoplasms are quite uncommon. They are detected in fewer than 0.5 percent of appendectomies and less than 0.5 percent of all gastrointestinal neoplasms. Similar to a colonic adenoma, an appendiceal adenoma is neoplasm with precancerous nature. A rare case of appendiceal adenoma is presented here in a 65-year-old female patient, incidentally discovered at the orifice of the appendix, during the screening analysis. The patient felt well. Abdominal examination and laboratory analysis were regular. Due to the inaccessibility of the lesion by colonoscopy, surgical treatment was recommended. A laparoscopic appendectomy was performed. On pathological examination, diagnosis of tubulovillous adenoma was performed. Endoscopic screening analysis of precancerous appendiceal neoplasm is very important. The method of choice for any appendiceal neoplasm is surgical removal i.e. appendectomy, preferably with a clean caecal margin, which requires stapling of the cecum. Early detection can prevent complications and decrease the risk of consequential appendiceal or colorectal carcinoma.

This scoping review examines the use of CRISPR/Cas9 gene editing in glioblastoma (GBM), a predominant and aggressive brain tumor. Categorizing gene targets into distinct groups, this review explores their roles in cell cycle regulation, microenvironmental dynamics, interphase processes, and therapy resistance reduction. The complexity of CRISPR-Cas9 applications in GBM research is highlighted, providing unique insights into apoptosis, cell proliferation, and immune responses within the tumor microenvironment. The studies challenge conventional perspectives on specific genes, emphasizing the potential therapeutic implications of manipulating key molecular players in cell cycle dynamics. Exploring CRISPR/Cas9 gene therapy in GBMs yields significant insights into the regulation of cellular processes, spanning cell interphase, renewal, and migration. Researchers, by precisely targeting specific genes, uncover the molecular orchestration governing cell proliferation, growth, and differentiation during critical phases of the cell cycle. The findings underscore the potential of CRISPR/Cas9 technology in unraveling the complex dynamics of the GBM microenvironment, offering promising avenues for targeted therapies to curb GBM growth. This review also outlines studies addressing therapy resistance in GBM, employing CRISPR/Cas9 to target genes associated with chemotherapy resistance, showcasing its transformative potential in effective GBM treatments.

Introduction: Fear of intervention in the oral cavity is declared as dental fear and is defined as a specific form of anxiety. The reaction to oral-surgical intervention will also depend on the feeling the patient acquires about the operator, but the positive experience also plays an important role.Aim: The aim is to evaluate differences between the sexes and the influence of experience from a previous oral surgical intervention on a similar subsequent intervention.Material and methods: In the research, anxiety was assessed using Corah's Dental Anxiety Scale (DASR) and Spielberger's State-Trait Anxiety Inventory (X1 and X2). The study included adult patients of both sexes with an indication for surgical extraction of impacted third permanent molars. Preoperative and postoperative anxiety was assessed: 1st measurement (day of examination) - DASR, and STAI (X1 and X2); 2nd measurement (immediately before the intervention) – STAI (X1 and X2); 3rd measurement (day after the intervention) – STAI (X1 and X2).Results: Preoperatively determined high levels of general, immediate, and dental anxiety decreased before the surgical procedure itself and were significantly reduced in the postoperative period. The downward trend continued in line with the positive experience. Women had higher anxiety scores than men for all monitored parameters. The use of the STAI scales to assess anxiety by dental practitioners is on par with other well-known anxiety assessment instruments, such as the DASR. Conclusion: In order to increase patient satisfaction and to prevent possible complications in such oral-surgical procedures, it would be useful to consider adequate therapy for high anxiety.

This review paper explores the use of miswak, a teeth-cleaning twig made from the Salvadora persica plant, in maintaining oral hygiene and preventing oral diseases. Various aspects of miswak are analyzed, including its historical significance, chemical composition, pharmacological characteristics, and beneficial effects on oral health. The paper also investigates the Islamic perspective on oral hygiene and the use of miswak, as well as the socio-medical aspect of oral disease prevention. While there are studies that point out potential drawbacks of miswak usage, proper application and combination with conventional oral hygiene methods can result in good oral health. Considering its cost-effectiveness and the need for affordable oral hygiene methods, further research on the use of miswak is valuable and necessary. This paper provides an overview of modern and relevant scientific literature on miswak and its significance in maintaining oral health, highlighting its journey from tradition to paradigm. Keywords: miswak, oral health, social medicine.

Introduction: Basal cell carcinoma is the most common non melanoma skin cancer. It accounts for approximately 80% of all skin cancers. Case report: We presented a 62-year-old patient with a giant, deeply infiltrative, destructive lesion of the head which lasted for 15 years. Microbiological analysis showed contamination, computed tomography (CT) scan showed deep infiltration and bone destruction. The risks of operative treatment were numerous. The treatment was more complicated by infection, infiltrative spreading and the patient's comorbidity. Regardless, we decided on a wide surgical resection with pathohistological evaluation of the resection margins. The patient denied oncological treatment. After 10 years, there were no recurrent tumours. Conclusion: Aggressive surgical treatment is the treatment of choice for giant basal cell carcinoma. In the case of giant locally aggressive and advanced neoplasms, when surgery is not appropriate or not possible, medical treatment becomes oncological.

This systematic review assesses current molecular targeted therapies for glioblastoma multiforme (GBM), a challenging condition with limited treatment options. Using PRISMA methodology, 166 eligible studies, involving 2526 patients (61.49% male, 38.51% female, with a male-to-female ratio of 1.59/1), were analyzed. In laboratory studies, 52.52% primarily used human glioblastoma cell cultures (HCC), and 43.17% employed animal samples (mainly mice). Clinical participants ranged from 18 to 100 years, with 60.2% using combined therapies and 39.8% monotherapies. Mechanistic categories included Protein Kinase Phosphorylation (41.6%), Cell Cycle-Related Mechanisms (18.1%), Microenvironmental Targets (19.9%), Immunological Targets (4.2%), and Other Mechanisms (16.3%). Key molecular targets included Epidermal Growth Factor Receptor (EGFR) (10.8%), Mammalian Target of Rapamycin (mTOR) (7.2%), Vascular Endothelial Growth Factor (VEGF) (6.6%), and Mitogen-Activated Protein Kinase (MEK) (5.4%). This review provides a comprehensive assessment of molecular therapies for GBM, highlighting their varied efficacy in clinical and laboratory settings, ultimately impacting overall and progression-free survival in GBM management.

Introduction: Insulin resistance (IR) is a complex pathophysiological condition multifactorial etiology characterized by diminished responsiveness of insulin target tissues. Today, various diagnostic approaches involving different laboratory parameters are available, but simple and non-invasive indices based on mathematical models are increasingly used in practice. This study aims to assess the effectiveness of various clinical surrogate indices in predicting IR across a population with varying body weights. Methods: The matched case-control study was conducted between January 2021 and December 2022. Secondary data extracted from the medical records of 129 subjects was analyzed, including demographic characteristics (age and gender), anthropometric measures (height and weight), and biochemical laboratory test results. y further divided into two subgroups based on body mass index (BMI): overweight (BMI between 25 and 29.9 kg/m2) and obese (BMI of 30 kg/m2 or higher). Using laboratory data values for six widely used clinical surrogate markers were calculated: Homeostatic model assessment for IR (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), Mcauley index (MCAi), metabolic score for IR (METS-IR), Triglyceride to Glucose Index (TyG), and TyG to BMI (TyG-BMI). Results: Significant differences in HOMA-IR levels were observed between the groups (p < 0.001). A similar pattern was found for the TyG-BMI, with notable differences (p < 0.001). The obese participants had the highest mean levels for METS-IR and the TyG index while the control group had the highest mean values for the QUICKI and MCAi indices (p < 0.001). According to the analysis, three indices showed statistical significance in predicting IR independent of BMI (p < 0.05). Sensitivity and specificity were higher in the obese group (0.704 and 0.891) than in the overweight group (0.631 and 0.721). Conclusion: Given that IR is a multifactorial disease, using derived indices based on a combination of biochemical parameters and anthropometric indicators can significantly aid in predicting and mitigating numerous complications.

Background and Objectives: Cranial defects pose significant challenges in low and middle-income countries (LIMCs), necessitating innovative and cost-effective craniofacial reconstruction strategies. The purpose of this study was to present the Bosnia and Herzegovina model, showcasing the potential of a multidisciplinary team and 3D-based technologies, particularly PMMA implants, to address cranial defects in a resource-limited setting. Materials and Methods: An observational, non-experimental prospective investigation involved three cases of cranioplasty at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between 2019 and 2023. The technical process included 3D imaging and modeling with MIMICS software (version 10.01), 3D printing of the prototype, mold construction and intraoperative modification for precise implant fitting. Results: The Bosnia and Herzegovina model demonstrated successful outcomes in cranioplasty, with PMMA implants proving cost-effective and efficient in addressing cranial defects. Intraoperative modification contributed to reduced costs and potential complications, while the multidisciplinary approach and 3D-based technologies facilitated accurate reconstruction. Conclusions: The Bosnia and Herzegovina model showcases a cost-effective and efficient approach for craniofacial reconstruction in LIMICs. Collaborative efforts, 3D-based technologies, and PMMA implants contribute to successful outcomes. Further research is needed to validate sustained benefits and enhance craniofacial reconstruction strategies in resource-constrained settings.

Advancements in neurosurgical visualization have been made possible by the introduction of the operating microscope (OM) and the emergence of exoscopic technology (EX). Both OMs and EXs provide enhanced magnification and illumination, but they come with their own set of advantages and disadvantages. OMs provide high-quality magnification and illumination and have been used successfully in a variety of surgical procedures. They can be customized to fit the specific needs of the surgeon and are a well-established technology. However, they can be bulky, expensive, and cause discomfort during extended procedures. EXs provide high-definition magnification and illumination, improved depth perception and ergonomics, and can be cost-effective. They can be customized to fit the specific needs of the surgeon and can be made using locally available materials, reducing the need for expensive imports. However, they may require adjustment and have a learning curve for surgeons who are used to operating with OMs. Additionally, they may have limited availability in some healthcare settings. The choice between OMs and EXs will depend on the specific needs of the surgeon and the healthcare setting. The integration of 3D EX systems has revolutionized neurosurgery, offering improved depth perception and ergonomics. EX's cost-effectiveness addresses accessibility concerns, making it an attractive alternative, particularly for low and middle-income healthcare settings. The exoscope seems to be a safe alternative compared to an operative microscope for the most common brain and spinal procedures. The exoscope may help expand access to neurosurgical care and training worldwide. In conclusion, both technologies have their own set of advantages and disadvantages, and the choice between them will depend on the specific needs of the surgeon and the healthcare setting.