<p><strong>Aim</strong> Any aesthetic procedure in the head and/or in the face might have an impact on psychological status of the treated participants. Aim of this study was<strong> </strong>to investigate whether Botulinum toxin treatment for aesthetic purpose in the face influences on the level of happiness, depression and anxiety.</p> <p><strong>Methods</strong> This prospective cohort observational study included 30 participants, who were treated by botulinum toxin (Botox) due to aesthetic corrections. The treatment included laugh lines, frown lines and horizontal forehead lines. Preprocedural, three and six months after the treatment the participants were assessed by The Oxford Happiness Questionnaire (OHQ), The Beck Depression Inventory (BDI) and The Beck Anxiety Inventory (BAI) to determine the level of happiness, anxiety and depression was used.</p> <p><strong>Results</strong> Three months after the treatment by Botox the level of happiness was significantly increased (5.26&plusmn;0.43 vs 4.3&plusmn;0.34; p&lt;0.0001). The levels of depression (7.6&plusmn;6.0 vs 14.2&plusmn;8.3; p&lt;0.0001) and anxiety (8.8&plusmn;6.3 vs 16.4&plusmn;8.8; p&lt;0.0001) were significantly decreased compared with preprocedural level. Significant increased level of happiness and decreased levels of depression and anxiety remained six months after the treatment, but attenuated. A dose of applied botulinum toxin was negatively correlated with the level of depression (r = -0.394; p=0.0421) and anxiety (r = -0.387; p=0.0302).</p> <p><strong>Conclusion </strong>Botulinum toxin treatment for aesthetic purpose in the face positively influences psychological status of the treated individual in the short-therm.</p>

Background Non-ST-elevation myocardial infarction (NSTEMI) is frequently associated with systemic inflammation and metabolic dysregulation. Indices derived from routine laboratory tests that reflect systemic inflammatory and lipid-inflammatory status may offer better prognostic insight. This study aimed to evaluate the association between selected indices and short-term major adverse cardiovascular events (MACE) and all-cause mortality in patients with NSTEMI treated with dual antiplatelet therapy (DAPT) and statin. The selected indices reflect key mechanisms involved in NSTEMI pathophysiology, including insulin resistance, atherogenic dyslipidemia, and inflammation. Materials and methods This prospective observational study included 171 patients with NSTEMI admitted to the Intensive Care Unit of the Clinic for Internal Medicine at the University Clinical Centre Tuzla between February 1, 2022, and January 31, 2023. Blood samples were collected upon admission and 24 hours subsequently. The following indices were calculated: triglyceride-glucose index (TyG), triglyceride-to-high-density lipoprotein ratio (TG/HDL), atherogenic index of plasma (AIP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and pan-immune-inflammation value (PIV). Outcomes were tracked during hospitalization and up to three months post-discharge. MACE was defined as cardiovascular death, reinfarction, stroke, or unplanned revascularization. All patients underwent coronary angiography; revascularization was performed when clinically indicated. Exclusion criteria included active malignancy, infection, or inflammatory disease. Logistic regression was adjusted for age, diabetes, and other clinical variables. Missing data were handled using the pairwise deletion method. Results High levels of TyG at admission were independently associated with MACE (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.0-2.8; p = 0.037). All-cause mortality occurred in 14.6% of patients (n = 25), while MACE occurred in 60 patients. Independent predictors of mortality included elevated TyG at admission (OR 2.2; 95% CI 1.1-4.4; p = 0.034), TG/HDL at 24 hours (OR 1.4; 95% CI 1.1-1.7; p = 0.007), AIP at 24 hours (OR 5.7; 95% CI 1.1-28.9; p = 0.035), and NLR at 24 hours (OR 1.1; 95% CI 1.0-1.2; p = 0.002). PLR and PIV at 24 hours were also significantly associated with mortality. Optimal cut-off values were TyG ≥ 8.9, AIP ≥ 0.35, and NLR ≥ 4.5. NLR had the highest estimated area under the curve (AUC ≈ 0.78). Conclusion In NSTEMI patients treated with DAPT and statin, several inflammatory and lipid-inflammatory indices were independently associated with short-term mortality. Indices measured at 24 hours had a stronger prognostic value than baseline values. Serial monitoring may aid early risk stratification. Outcomes were assessed during hospitalization and via structured follow-up up to three months post-discharge.

Background Acute cholecystitis (AC) is a frequent surgical emergency associated with significant variability in clinical outcomes and hospital length of stay (LOS). Early identification of patients at risk for prolonged hospitalization can improve triage and resource planning. Inflammatory markers such as C-reactive protein (CRP), white blood cell count (WBC), and total bilirubin (TBil), along with biliary complications like choledocholithiasis and Mirizzi syndrome, may have prognostic value. Materials and methods This retrospective study included 150 patients who underwent cholecystectomy for AC at the Department of General and Abdominal Surgery, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina, between January 1, 2024, and January 31, 2025. Demographic, laboratory, and intraoperative data were collected. Receiver operating characteristic (ROC) analysis identified optimal cut-offs for inflammatory markers predicting prolonged LOS (≥7 days). Multivariate linear regression was used to assess independent predictors, including CRP, WBC, TBil, and intraoperative findings. Results We found that CRP was significantly higher in patients with prolonged LOS and demonstrated the highest predictive accuracy, with an area under the curve (AUC) of 0.733 (95% CI: 0.630-0.835), followed by TBil and WBC. In multivariate analysis, only CRP ≥110.5 mg/L (p<0.001), the presence of choledocholithiasis in 26 patients (17.3%; p=0.010), and Mirizzi syndrome in seven patients (4.7%; p=0.017) remained significant predictors. WBC and TBil lost significance after adjustment. Conclusion CRP is the most reliable independent laboratory predictor of prolonged LOS in AC. The presence of choledocholithiasis and Mirizzi syndrome further contributes to extended hospitalization. These factors should be considered in early clinical risk assessment.

Background Non-ST-elevation myocardial infarction (NSTEMI) represents a prevalent form of acute coronary syndrome associated with substantial early risk of adverse outcomes. Inflammatory and metabolic disturbances are increasingly recognized as key contributors to the disease. Hematologic indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV), along with the triglyceride-glucose index adjusted for BMI (TyG-BMI), have emerged as promising prognostic markers. However, their dynamic behavior in early NSTEMI remains insufficiently explored. Materials and methods This prospective study included 170 patients hospitalized for NSTEMI at the University Clinical Centre Tuzla between February 2022 and January 2023. Hematologic and metabolic indices were calculated at admission and repeated 24 hours later. Patients were followed for three months to document major adverse cardiovascular events (MACE), including cardiovascular death, reinfarction, and urgent revascularization. The median age was 67 years, and 60.6% of patients were male. Hypertension, hyperlipidemia, and diabetes mellitus were the most common comorbidities. Results Significant 24-hour reductions were observed in NLR, PLR, SII, SIRI, and PIV (all p < 0.01), while C-reactive protein (CRP) levels more than doubled (p < 0.001). Patients who developed MACE showed persistently elevated inflammatory indices and smaller declines in PIV and SIRI. Change in SIRI (ΔSIRI) demonstrated the strongest predictive value (AUC = 0.63), followed by SII and TyG-BMI. Notably, reduced resolution of PIV and persistently elevated TyG-BMI were significantly associated with adverse outcomes. Overall, MACE occurred in 51.2% of patients, including a 14.7% mortality rate. Conclusion Early changes in systemic inflammation and metabolic stress, particularly SIRI and TyG-BMI dynamics, offer valuable prognostic insight and may enhance early risk stratification in NSTEMI patients.

Background Heart failure (HF) is characterized by impaired cardiac function. Based on left ventricular ejection fraction (LVEF), it is classified into HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF). Each phenotype has distinct pathophysiological mechanisms and clinical features. Recent findings indicate that systemic inflammation is a significant factor in the progression of heart failure. Inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and lymphocyte-to-monocyte ratio (LMR), may serve as valuable tools for evaluating the inflammatory response in heart failure. Materials and methods This prospective observational study, which included 171 HF patients, was conducted from February 2022 to January 2023 at the Intensive Care Unit, University Clinical Centre Tuzla. Based on LVEF, patients were categorized into HFrEF, HFmrEF, and a control group (HFpEF). The study aimed to assess the prognostic value of NLR, MLR, and LMR in predicting major adverse cardiovascular events (MACE) and mortality over a 12-month follow-up period. Results NLR and MLR were significantly higher, while LMR was lower in both HFrEF and HFmrEF compared to controls, indicating a strong inflammatory response, particularly in HFrEF. NLR demonstrated a strong ability to distinguish between HF phenotypes. HFmrEF's markedly higher high-sensitivity troponin I (hsTroponin I) level suggested higher cardiac stress. MACE rates were similar across groups; mortality was significantly higher in HFrEF. Conclusion Inflammatory biomarkers NLR, MLR, LMR, and hsTroponin I could be crucial in assessing heart failure, particularly in patients with HFrEF and HFmrEF.

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.

The aim of the current research was to investigate the association between plasma endocan levels and metabolic control parameters, as well as to evaluate its predictive value for clinical complications in patients with type 2 diabetes mellitus (DMT2). A total of 100 DMT2 patients participated in this prospective observational study. Plasma endocan levels were significantly elevated in DMT2 patients with HbA1c > 7% (1.38 ± 0.33 vs 0.68 ± 0.23 ng/mL; P < 0.0001), compared to patients with HbA1c ≤ 7%. Patients with plasma endocan concentrations >1.10 ng/mL (median value of 1.10 ng/mL) demonstrated significantly higher levels of metabolic parameters: body mass index (BMI), HbA1c (%), fasting glucose level, LDL cholesterol, total cholesterol, triglycerides, along with significantly lower HDL cholesterol levels. Furthermore, patients with plasma endocan levels >1.10 ng/mL were found to have an increased risk for the following complications: retinopathy (relative risk [RR]: 2.7500; 95% confidence interval [CI]: 1.2150–6.2244; P ═ 0.0152, nephropathy (RR: 2.0952; 95% CI: 1.2294–3.5710; P ═ 0.0065), neuropathy (RR: 1.9945; 95% CI: 1.2025–3.3081; P ═ 0.0075), angina pectoris (RR: 2.4881; 95% CI: 1.0865–5.6979; P = 0.0311, hypertension (RR: 1.1372; 95% CI: 1.0060–1.2856; P = 0.0398), cardiomyopathy (RR: 2.6190; 95% CI: 1.1507–5.9612; P = 0.0218), myocardial infarction (RR: 9.4286; 95% CI: 1.2742–69.7697; P = 0.0280) and stroke (RR: 4.4638; 95% CI: 1.3765–14.4758; P = 0.0127). Correlation analysis revealed that plasma endocan levels were positively correlated with HbA1c (%) (r ═ 0.856, P < 0.0001), fasting glucose level (r ═ 0.631, P < 0.0001), LDL (r ═ 0.347, P ═ 0.0004), cholesterol (r ═ 0.282, P ═ 0.0045), and triglycerides (r ═ 0.366, P ═ 0.0002). Conversely, plasma endocan levels were negatively correlated with HDL cholesterol (r ═ −0.429, P < 0.0001). In conclusion, higher plasma endocan levels were strongly associated with poor metabolic control in DMT2 patients and exhibited significant predictive value for both microvascular and macrovascular complications.

AIM 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. METHODS 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. RESULTS 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. CONCLUSION 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.

Background: The development of novel medical imaging technologies and treatment procedures hinges on the availability of accurate and versatile phantoms. This paper presents a cost-effective approach for creating anthropomorphic abdominal phantoms. Methods: This study proposes a cost-effective method using 3D printing and readily available materials (beeswax, plaster, and epoxy resin) to create high-fidelity anthropomorphic abdominal phantoms. The three-dimensionally printed phantoms exhibited X-ray attenuation properties closely matching those of human tissues, with measured Hounsfield unit (HU) values of −115.41 ± 20.29 HU for fat, 65.61 ± 18.06 HU for muscle, and 510 ± 131.2 HU for bone. These values were compared against patient images and a commercially available phantom, and no statistically significant difference was observed in fat tissue simulation (p = 0.428). Differences were observed for muscle and bone tissues, in which the 3D-printed phantom demonstrated higher HU values compared with patient images (p < 0.001). The 3D-printed phantom’s bone simulation was statistically like that of the commercially available phantom (p = 0.063). Conclusion: This method offers a cost-effective, accessible, and customizable alternative for abdominal phantoms. This innovation has the potential to accelerate advancements in abdominal imaging research, leading to improved diagnostic tools and treatment options for patients. These phantoms could be used to develop and test new imaging techniques with high accuracy.

Aim To create a predictive score based on functional parameters of the liver and determine its prognostic value in survival of patients with decompensated cirrhosis. Methods Retrospective observational study included 91 consecutive patients with decompensated cirrhosis. Functional parameters (bilirubin, AST - aspartate aminotransferase, ALT - alanine aminotransferase, ALP - alkaline phosphatase, GGT - gammaglutamyltranferase, albumin, prothrombin time, platelet count, haematocrit and creatinine), Child-Pugh (CP) and Model of EndStage Liver Disease (MELD) scores have been measured at first hospitalization and at every exacerbation episode over follow-up period of 24 months. Results Using Cox regression analysis, we found that age (OR=1.206; p=0.03; 95% CI=1.019-1.428), serum bilirubin (OR=1.017; p=0.003; 95% CI=1.006-1.029), INR (International normalized ratio) (OR=6.262; p=0.002; 95% CI=1.924-20.378) and serum creatinine (OR=1.019; p=0.005; 95% CI=1.006- 1.032) had statistically strong association with the incidence of a six-month mortality. Age (OR=1.120; p=0.006; 95% CI=1.033- 1.214), serum bilirubin (OR=1.021; p=0.0001; 95% CI=1.010- 1.032), GGT (OR=1.007; p=0.023; 95% CI=1.001-1.014), INR (OR=9.571; p=0.001; 95% CI=2.610-35.098), haematocrit (OR=0.695; p=0.001; 95% CI=0.559-0.864) and serum creatinine (OR=1.023; p=0.0001; 95% CI=1.011-1.035) showed an increased the risk for a 24-month lethal outcome. Predictive score derived from liver functional parameters, CP and MELD scores, each independently has shown a high degree of death prediction after 6 or 24 months in patients with end-stage liver disease. Conclusion Predictive score derived from liver functional parameters had a better prognostic value for short-term and long-term mortality comparing to MELD and Child-Pugh score.

Simple Summary Merkel cell carcinoma (MCC) is a rare and highly aggressive type of skin neuroendocrine cancer that frequently recurs and metastasizes within a relatively short period. Despite rapid growth and characteristic skin color, MCC often goes undiagnosed in its early stage. Therefore, therapy is often initiated at the advanced stage, and selecting appropriate therapeutic interventions is critical. The emergence of novel immunotherapeutic agents, such as immune checkpoint inhibitors (ICI), presents a promising treatment option for advanced MCC. Several biomarkers, such as PD-L1 expression, tumor mutational burden (TMB), and microsatellite instability (MSI), showed significant potential as predictive biomarkers for treatment with ICI. Despite their predictive value, each has demonstrated limited value in MCC over recent years. Abstract Merkel cell carcinoma (MCC) is primarily a disease of the elderly Caucasian, with most cases occurring in individuals over 50. Immune checkpoint inhibitors (ICI) treatment has shown promising results in MCC patients. Although ~34% of MCC patients are expected to exhibit at least one of the predictive biomarkers (PD-L1, high tumor mutational burden/TMB-H/, and microsatellite instability), their clinical significance in MCC is not fully understood. PD-L1 expression has been variably described in MCC, but its predictive value has not been established yet. Our literature survey indicates conflicting results regarding the predictive value of TMB in ICI therapy for MCC. Avelumab therapy has shown promising results in Merkel cell polyomavirus (MCPyV)-negative MCC patients with TMB-H, while pembrolizumab therapy has shown better response in patients with low TMB. A study evaluating neoadjuvant nivolumab therapy found no significant difference in treatment response between the tumor etiologies and TMB levels. In addition to ICI therapy, other treatments that induce apoptosis, such as milademetan, have demonstrated positive responses in MCPyV-positive MCC, with few somatic mutations and wild-type TP53. This review summarizes current knowledge and discusses emerging and potentially predictive biomarkers for MCC therapy with ICI.

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 association between urine amylase levels and the development of post-operative complications after Whipple resection is still unknown. The aim of this study was to determine the prognostic value of urine amylase levels for post-operative complications in patients who underwent Whipple resection. In this retrospective-prospective cohort study we analyzed amylase levels in urine, serum, and drains in 52 patients who underwent Whipple resection preoperatively and on Post-operative Day 1 (POD1) after the intervention. Patients were followed up for 3 months to assess their predictive value for post-operative complications. In patients with complications, urine amylase levels were significantly higher on POD1 than before resection (198.89 ± 28.41 vs. 53.70 ± 7.44, p=0.000). Considering the sensitivity and specificity of the urine amylase level on POD1, an area under the ROC curve of 0.918 was obtained (p<0.001, 95% Confidence interval [CI]: 0.894-0.942). Patients with urine amylase levels ≥140.00 U/L had significantly higher risks of post-operative pancreatic fistula (POPF) grade C (definition of POPF done according to the ISGP) (RR:20.26; 95% CI: 1.18-347.07; p=0.038), readmission to hospital (RR: 6.61; 95% CI: 1.53-28.58; p=0.011), reoperation (RR: 5.67; 95% CI: 1.27-25.27; p=0.023), and mortality (RR:17.00; 95% CI: 2.33-123.80; p=0.005) than patients with urine amylase levels <140.00 U/L. Urine amylase levels on POD1 displayed strong and significant positive correlations with serum amylase levels (r=0.92, p=0.001) and amylase levels in drains (r=0.86, p=0.002). We can conclude that urine amylase levels on POD1 have good prognostic value for post-operative complications after Whipple resection and might be used as an additional predictive risk factor.