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

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

PROBLEM The aim of this study was to quantify and compare the distribution of regulatory CD25+ FOXP3+ and activated CD4+ CD25+ T cells in decidua basalis and parietalis of severe and mild pre-eclampsia (PE) to normal healthy pregnancies. METHOD OF STUDY Decidual tissue (decidua basalis and parietalis) of 13 women with mild PE, 15 women with severe PE and 19 women with healthy term pregnancies were analyzed by immunohistochemistry and double immunofluorescence. RESULTS The total number of CD25+ FOXP3+ cells/mm2 in decidua basalis was decreased in the severe and mild PE versus normal pregnancy group. The total number of CD4+ CD25+ cells/mm2 in decidua basalis was decreased in the severe PE versus normal pregnancy group. The number of CD25+ FOXP3+ and CD4+ CD25+ cells in decidua parietalis was decreased in both PE groups. CONCLUSION Our data suggest that immunological changes of PE reflect on decidua basalis and parietalis and emphasize the importance of characterizing T cells in both decidual departments.

Background: Congenital cytomegalovirus infection (cCMV) is a leading cause of sensorineural hearing loss (SNHL) and neurodevelopmental disabilities in developed countries. Although high cCMV rates have been reported in populations with high seroprevalence, the cCMV prevalence in low/middle-income countries in Europe has not been defined. Objective: To determine cytomegalovirus (CMV) seroprevalence and the cCMV prevalence in Bosnia and Herzegovina. Methods: Between March 2010 and February 2019, 5222 sera samples from patients seen at the University Clinical Hospital Mostar were tested for CMV IgG. The cord blood samples collected from 2091 infants between July 2011 and January 2013 were analyzed for CMV IgG and CMV DNA. The cCMV prevalence was determined by testing saliva swabs from 1293 infants between November 2015 and October 2016. Results: The overall CMV IgG prevalence was 81.4% (95% confidence interval: 0.8–0.82). Significantly higher prevalence was observed among females (84.9%) than in males (77.0%), and the rate increased from 50.8% in the 1 to 5 years group to 97.7% in the group > 65 years old. Most cord blood samples (2091/1925, 92.1%) were CMV IgG positive, and 2 (0.1%) were CMV DNA positive. Of the 1293 saliva swabs, 8 (0.62%; 95% confidence interval: 0.3–1.2) were CMV positive. All 8 infected infants had asymptomatic cCMV, and none had SNHL at 18 months of age. Conclusions: In a highly CMV seropositive population, the prevalence of cCMV was lower compared with that reported from other low/middle-income countries populations. None of the infected infants had symptomatic infection or SNHL at 18 months.

Aim To examine whether there are differences in the experience in giving informed consent of patients whose surgery was elective compared to emergency surgery in the same department. Methods A prospective cross-sectional study was conducted in the Department of Gynaecology and Obstetrics of University Clinical Hospital Mostar during a 6-month period. The sample of respondents consisted of two groups of patients, 145 with elective surgery and 90 patients with emergency surgery. The study was conducted using an anonymous questionnaire. Results Patients in both examined groups were equally satisfied with the procedure of informed consent. Most patients signed the informed consent at the request of a nurse, 195 (83%). During the process of consenting, almost all patients, regardless of whether they had elective or emergency surgery, claimed that they understood the form, which had to be signed, it was important to them, 230 (97.9%), except the patients who had elective surgery, 130 (90.3%), regularly stated that having an opportunity to ask questions was important to them. Respondents with emergency surgery more frequently agreed to sign whatever was in the form, 42 (46.7%). Conclusion Patients who had a planned surgery and patients who had an urgent surgery, mostly declare contentment with the use of informed consent although they did not have the same experience about informed consent.

Background: The prevalence of gestational diabetes mellitus (GDM), as a complex problem in pregnancy, is increasing all over the world, but most noticeable in developing countries. Aims: To estimate GDM prevalence and associated pregnancy features in the southern part of Bosnia and Herzegovina. Methods: A cross-sectional observational study was conducted from October 2010 through March 2011. A total of 285 pregnant women with singleton pregnancies participated and were asigned to the study in the order they came for their usual ante-natal clinic examination. They underwent an oral glucose tolerance test (OGTT) with 75 g of glucose. Information on OGTT results, maternal characteristics and pregnancy outcomes were collected from database and medical records. Results: Prevalence of GDM was 10.9% according to 1999 World Health Organisation (WHO) diagnostic criteria. Prenatal cigarette smoking, previous GDM, cesarean delivery rate and neonatal hypoglycemia were significantly more frequent in the GDM group compared to the group of pregnancies with normal glucose tolerance (p = 0.015, p < 0.001, p = 0.015, p = 0.002). Conclusion: This study presents a relatively high prevalence of GDM in Bosnia and Herzegovina. There is a need for large well-designed study on GDM prevalence and its other features.

Preterm delivery before 37 gestational weeks is a major challenge in perinatal health care. Over the past 30, the incidence of preterm delivery in most developed countries has been about 7–10% of live births. Some evidence shows that this incidence has increased slightly in the past few years, but the rate of birth before 32 weeks' gestation is almost unchanged, at 1-2%. Several factors have contributed to the overall rise in the incidence of preterm delivery. These factors include increased use of assisted reproduction techniques, increasing rates of multiple births, and more obstetric intervention. Progesterone is the key hormone maintaining pregnancy. Numerous progesterone effects can be demonstrated by laboratory studies involving every tissue of the reproductive tract, the myometrium, decidua, cervix, and fetal membranes. In particular, progesterone can alter the response to cytokines, inhibit prostaglandin and nitric oxide synthesis, reduce corticotrophin-releasing hormone (CRH) synthesis, block cervical stromal degradation, and induce cervical stromal matrix protein secretion. By altering both the mechanical and physiologic functions of the cervix, cervical performance may be substantially enhanced by these agents. Presumably, progesterone may alter the rate of cervical stromal degradation via altering secretion of matrix metalloproteases by diminishing prostaglandin and nitric oxide synthesis and minimizing neutrophil recruitment. The diverse aetiology of preterm delivery makes its prediction difficult. A substantial part of unexplained preterm deliveries might be attributable to a deleterious immune response of the mother toward the foetus. A growing body of evidence suggests that progesterone might play a significant role in establishing an adequate immune environment during the early stages of pregnancy. In the presence of progesterone, lymphocytes of pregnant women release a protein named the progesterone induced blocking factor (PIBF)7 which mediates the immunomodulatory and antiabortive effects of progesterone. Immunologic recognition of pregnancy and subsequent activation of maternal immune system result in an upregulation of progesterone receptors on activated lymphocytes among placental cells and CD8+ cells. In the presence of sufficient progesterone levels, these cells synthesize PIBF. Patients at risk of preterm delivery presented increased proinflammatory cytokines, low PIBF, and reduced IL-10 expressions on lymphocytes. PIBF alters the profile of cytokine secretion of activated lymphocytes shifting the balance toward Th2 dominance. During a normal uneventful pregnancy, the concentration of PIBF continuously increases from the 7th to the 37th gestational weeks. After the 41st week of pregnancy, PIBF concentrations dramatically decrease. In patients with a diagnosis of threatened premature labour, studies have shown that PIBF levels failed to increase during pregnancy. Identification of women with risk for preterm delivery would be a key for its prevention. No sufficiently specific marker, however, has so far been found. The diverse aetiology of preterm birth makes its prediction difficult. This special issue will give as some useful information but also questions which are important for our understanding of pathophysiology, prevention, diagnosis, and treatment of preterm birth. Igor  Hudic Babill  Stray-Pedersen Vajdana  Tomic