Background: Compression of the ulnar nerve at the level of Guyon’s canal is a very rare compressive neuropathy. Due to the vast range of symptoms that can manifest depending on the degree of ulnar nerve compression, the clinical picture is not consistent. Objective: The aim of the study is to outline the diagnostic techniques and therapeutic options. Case report: We reported a case of ganglion cyst-induced compression of the ulnar nerve in Guyon’s canal. A 45-year-old female patient underwent surgical ulnar nerve release in Guyon’s canal at the Clinic for Plastic and Reconstructive Surgery. Discussion: After a thorough medical history and physical examination, the diagnosis of the syndrome is made, and ultrasound and magnetic resonance imaging (MRI) testing are used to determine the origin of the neuropathy. A ganglion cyst was identified pathohistological one month following the surgical excision of the soft tissue tumor. In order to hasten the patient’s nerve recovery, physical therapy was recommended, and the patient was monitored for the following two years. After two years of treatment, the patient has made a very good recovery of the functionally damaged hand, as determined by a modified Bishop scoring method for evaluating functional ulnar nerve recovery. Conclusion: In virtually all cases, early surgical intervention can lead to an outstanding functional recovery. If the symptoms are more severe and continue or get worse for more than three months, early surgical intervention is the gold standard for treating Guyon’s canal syndrome. If soft tissue formations are compressing the ulnar nerve in Guyon’s canal, MRI is thought to be the gold standard for diagnosis.

Background: Cardiovascular diseases (CVD) are the cause of 17 million deaths a year worldwide, of which 25% are sudden cardiac deaths (SCD). In Europe cardiovascular diseases (CVD) remains a leading cause of death in Europe accounting for 3.9 million deaths each year. Even with well-known risk factors and the current standards of health care, improvement of health and quality of life of CVD patients are still remains one of the biggest public health challenges we must overcome. Objective: The aim of this study was to analize of current strategic documents and relevant facts of WHO and other appropriate institutions regarding CVDs prevention and control for potentialy use in Bosnia and Herzegovina (B&H). Methods: Authors made a narrative review to provide a brief overview of the recent and relevant documents of good practice in prevention, diagnostic and therapeutic approaches of cardiovascular diseases that should be consider as milestones for the health authorities in the Federation of B&H. Results and Discussion: Bosnia and Herzegovina is among the countries with a high risk of CVD together with Albania, Croatia, Czech Republic, Estonia, Hungary, Kazakhstan, Poland, Slovakia, and Turkey. The main public health challenge in Bosnia and Herzegovina is reducing noncommunicable diseases (NCDs): heart disease, stroke, cancer, diabetes and chronic respiratory disease. NCDs are estimated to account for 80% of the country’s annual deaths, and addressing them is the foremost public health priority in the country. Cardiovascular diseases still represent a worldwide public health problem, with some new dimensions caused by challenges caused through pandemic of COVID-19. The well-known cardiovascular risk factors require new and more efficient public health approaches to the prevention and control. Conclusion: Due to the recently developed cardiovascular guidelines that were made by the European Society of Cardiology and World Heart Federation, key priority for health authorities should be is to update the existing CVD guidelines in the Federation of BiH in accordance with the international good practice to support healthcare professionals in their efforts to reduce the burden of cardiovascular disease in both individual patients, as well as at a population level..

Following modern global trends in the commercialization of education and adopting the lifelong learning concept, as well as rapid development of adult education in Bosnia and Herzegovina, this research connects the adult education field with one of the vital management models in each organization/company's practice – marketing management. The number of adult education providers is increasing, but practical tools and research of their scope of work are in deficit. With the intention to contribute to the improvement of the theory and practice of adult education and marketing management and to help adult education providers adjust their promotional messages to their target groups, for the purpose of this research, the population of adults is divided into four generations: Baby Boom, X, Y and Z. This research aims to understand opinions and attitudes of the four generation's representatives on the elements of the promotional mix of educational institutions and determine whether changes between them exist or not. A qualitative research approach has been used in collecting primary data with focus groups as the main research method. The final result of this research is a projection of twenty recommendations to adult education providers (public and private schools, organizations and adult education centers), which are not only applicable in these education institutions. Other companies and organizations creating offers for age-segmented markets could also benefit greatly from these recommendations.

Background: Pancreaticoduodenectomy (PD) known as Whipple procedure is still one of the most complex abdominal surgeries used for treatment of periampullary tumors. PD is often followed with postoperative complications (pancreatic, biliar or intestinal fistula, haemorrhage, intraabdominal abscess, delayed gastric empting. Severe postoperative complications (SPC) can be reason for reoperation and reason of bad outcome of treatment and life treathening condition. Objective: To investigate predicitive value of preoperative hypoalbuminemia for severe postoperative complications (SPC) in patients who have undergone Whipple pancreaticoduodenetomy (PD). However, no similiar study has been ever reported from our country until now. Methods: In this retrospective-prospective study, 100 patients who have had Whipple pancreaticoduodenectomy for malignant periampullary tumors at the Department for Surgery of University Clinic Center Tuzla, Bosnia and Herzegovina were enrolled, from january of 2009 to decembre of 2021. All patients were preoperatively analysed according to serum albumine levels and presensce of hypolabuminemia (serum albumine levels <32g/l). Serum albumine biochemical test were done 1-2 days preoperatively. Clavien Dindo classification was used for determination patients with SPC. Patients who did not have SPC belonged to (I-II) Clavien Dindo group of patients while those who had SPC belonged to( III-V) Clavien Dindo group of patients. Results: Out of 100 patients who have undergone pancreaticoduodenetomy, in 55 (55%) patients postoperative complications were noticed. Mortality rate was 18 (18%) and reoperation has been done in 20 cases (20%). SPC were noticed in 19 patients and most often were: delayed gastric emptying (20%), pancreatic fistula (13%) and intraabdominal collections (9%). Hypoalbuminemic patients had a significantly higher rate of severe postoperative complications ( p<0.05). Using hypoalbuminemia-SPC correlation analaysis, there is confirmed statistically significant correlation between hypoalbuminemia and SPC (ρ= 0.236; p<0.05). Conclusion: Preoperative hypoalbuminemia can be used as predictor and prognostic factor for severe postoperative complications after Whipple pancreaticoduodenectomy. Identification and optimization of serum albumin level prior to Whipple pancreatoduodenectomy may improve surgical outcomes.

Background: A bezoar is a collection of indigestible substances that, after swallowing, form a mass in the gastrointestinal tract, most often in the stomach. A trichobezoar is a mass made of ingested, undigested hairs and food remains, while ingestion of hair is called trichophagia. This is an extremely rare condition, with 90% of cases occurring among women, out of which 80% are under the age of 30. The diagnosis is based on clinical examination, findings obtained through radiological modalities (ultrasound and computed tomography) and endoscopy. Objective: The aim of this article is to present the case of a 17-year-old female patient who visited the doctor due to abdominal pain and a visible mass in the projection of the stomach. Case presentation: The patient, accompanied by her parents, and following the instructions of a general practitioner who suspected the presence of a tumour in the abdomen, reported to the surgical clinic. The US examination revealed the presence of a heteroechoic mass in the stomach area, but it could not be determined with certainty where it belonged (Samsung Medison V8 ultrasound system). The CT scans revealed the presence of an inhomogeneous structure in the stomach area occupying the entire volume of the stomach. The mentioned structure included the presence of internal air particles and marginal imbibition of the orally applied contrast agent. The described structure did not infiltrate the stomach wall and, based on the CT scan, the diagnosis established was a bezoar. Under general anaesthesia, a laparotomy with a gastrotomy was performed, and a hard hook shaped mass composed of hair and remains of undigested food was removed from the stomach. Conclusion: A mobile, palpable mass located in the abdomen of younger female patients accompanied by abdominal symptoms, especially in patients where there is information about hair pulling and swallowing, may suggest trichobezoar. The golden standard for trichobezoar presentation is upper endoscopy. If unavailable, the diagnosis is established by a CT scan, preferably with oral application of a contrast agent. Treatment of larger trichobezoars is surgical, while endoscopic and laparoscopic removal is possible only in the case of small trichobezoars.

Background: Pleural disorders in novel coronavirus disease 2019 (COVID-19), responsible for the deaths of more than 6.7 million people worldwide, are relatively uncommon and underappreciated findings. The severity of the pleural disease in these patients correlates with the treatment outcome and overall prognosis. Objective: We aim to review our experience with treatment modalities and prognosis in 45 patients with COVID-19, who were treated at our Clinic between April 2020 and October 2021. Methods: We conducted a retrospective, single-center, cross-sectional study. Demographic data, the type of thoracosurgical intervention(s), and treatment outcome for 45 patients included in this study were recorded for every patient. We analyzed the type and number of treatment modalities according to the pleural disorder, and the outcome of the treatment. Results: Pneumothorax was the most common COVID-19-related pleural disorder, followed by the pleural effusion. Tube thoracostomy was the mainstay of treatment, performed in 84.4% of patients with unilateral pleural complications. In total, 20% of our patients were on mechanical ventilation, and all of them had a fatal outcome. We found statistical significance in comparison to the percentage of fatal outcomes between patients treated with and without mechanical ventilation (p=0.000). Conclusion: COVID-19-related pleural disorders are prognostic markers of disease progression. Mechanically ventilated patients who require tube thoracostomy have an unfavorable prognosis.

Background: Discus hernia represents an intervertebral disk prolapse. The intervertebral disk provides stability in rest state and distributes the load of the spinal column on the move. Changes that lead to the occurrence of disc prolapse are desiccation, reduction of proteoglycan content, mucoid degeneration, and fibrosing tissue uptake. Predisposing factors of lumbar pain are heavy physical tasks with lifting loads over twenty pounds, especially professional use of heavy tools. Objective: The aims of this article is the review of diagnostics and physical therapy of lumbar disc herniation at levels L4/L5 and L5/S1. Methods: Authors used descriptive method for review lumbar disc herniation including diagnostic procedures and physical therapx based on scientific literature stored in medical databses PubMed, Scopus, Hinari, etc.. Results: The most common area of the spine to experience a herniated disk is the low back, just below the waist level. Herniated disks also commonly occur in the neck.. Conclusion: Rehabilitation is a delicate problem and requires long-term treatment and multidisciplinary cooperation, and is carried out in accordance with the principles of diagnostic and physical therapy of lumbar dics herniation depending of level of demaged and level of causes of lumbar disc herniation. The majority of herniated disks do not require surgery, and respond best to physical therapy. Physical therapists design personalized treatment programs to help people with herniated disks regain normal movement, reduce pain, and get back to their regular activities.

Background: The treatment strategy for non-muscle invasive bladder cancer (NMIBC) has not changed significantly over the past 30 years. Chemotherapeutic agents (mitomycin-C, epirubicin, etc.) and BCG (Bacillus Calmette-Guerin) immunotherapy are used as adjuvant intravesical therapy. Objective: To compare the difference between adjuvant chemotherapy and adjuvant immunotherapy in their efficacy of reducing the number of tumor recurrences. Methods: In this prospective clinical study, which included 99 patients with NMIBC from March 2018.–March 2023., we publish the results for all risk groups of patients treated with intravesical chemotherapy Epirubicin or with BCG immunotherapy, after TURBT (Trans urethral resection of bladder tumor) within 1 year. Patients were stratified into 2 groups. The first group was treated with Epirubicin (1 dose within 24 hours of surgery, then 6 weekly instillations and 3 maintenance doses), and the second group was treated with BCG (2-3 weeks after TURBT 6 weekly instillations, and 3 maintenance doses). The monitoring period was 24 months. Results: In patients treated with intravesical chemotherapy, recurrence occurred in 9 patients (17.64%), and in patients treated with BCG, recurrence occurred in 7 patients (14.58%). A similar incidence of disease recurrence was observed in both groups (p=0.787). Conclusion: The results of our study show a similar therapeutic response by risk groups of patients treated with chemotherapy and immunotherapy. Since BCG production will cease in the future, the task of urologists is to introduce intravesical chemotherapy into wider use and to modernize it as a safe and effective method of adjuvant treatment for non-muscle-invasive bladder cancer.

Introduction:The diagnosis of acute kidney injury (AKI) in preterm newborns with perinatal asphyxia based on increased serum creatinine (sCr) value and oliguria/anuria is usually delayed. The Aim of this paper is to evaluate serum cystatin C as an early predictor of AKI. Materials and methods:The study included 42 preterm newborns (24-37 weeks) with perinatal asphyxia (Apgar score (AS) ≤ 3 at 5 minutes of life or blood pH on admission ≤ 7.00). The sCr and sCysC levels were measured on the 1st, 3rd, and 7th day of life. According to KDIGO criteria, the newborns were classified into groups, and sCr and sCys-C values were compared. Results:The mean gestational age was 29.9 ± 3.0 weeks. AKI was diagnosed in 62.8 % of patients. Of these patients, 81.5% belonged to AKI 1 group, and 18.5 % to AKI 2 group.No newborns had the criteria for AKI 3. On day 7 the mean sCr values were significantly higher in AKI (65.4± 21.8) compared with the non-AKI group (168.4±38.2) (p<0.001), but not on day 1 and 3 (p = 0.322, 0.012, respectively). The sCys-C values were significantly higher in the AKI group on day 3 ( AKI vs. non-AKI group, 0.69 ±0.22 vs. 1.22 ±0.20; p <0.001) and day 7 (AKI vs. non-AKI group, 0.62 ±0.41 vs. 1.68 ±0.20; p <0.001). The sCys-C was also an earlier marker of a more severe stage of AKI than sCr. Conclusion:The sCys-C was elevated earlier than sCr, making it a valuable diagnostic tool for AKI in preterm newborns.

Background: In the last two decades diagnostic criteria for acute kidney injury (AKI) were developed: Risk, Injury, Failure, Loss of Kidney Function, End-Stage Kidney Disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. Objective: The study aimed to determine the incidence of AKI based on the RIFLE, AKIN, and KDIGO criteria, as well as analyze their predictive value for mortality and renal function outcome. Methods: This was a single-center prospective study of patients diagnosed with AKI. Acute kidney injury was defined and classified according to the RIFLE, AKIN, and KDIGO criteria. The outcomes were renal function outcome and in-hospital mortality. Results: The incidence rates of AKI based on the RIFLE, AKIN, and KDIGO criteria were 13.4%, 14-36%, and 14.64%, respectively. Multiple regression analysis showed that higher stages of AKI according to the KDIGO criteria were independently associated with non-recovery of renal function (p=0.011). However, the predictive ability of RIFLE, AKIN and KDIGO classifications for renal function recovery was poor (Area Under the Receiver Operating Characteristics-AUROC=0.599, AUROC=0.637, AUROC=0.659, respectively). According to the RIFLE and AKIN criteria, in-hospital mortality was statistically significantly higher in stage Failure/3 (p=0.0403 and p=0.0329, respectively) compared to stages Risk/1 and Injury/2. Receiver Operating Characteristics (ROC) analysis showed that all three classifications had poor predictive ability for in-hospital mortality (AUROC=0.675, AUROC=0.66, AUROC=0.681). Conclusions: KDIGO classification is an independent predictor of renal function non-recovery. However, by ROC analysis, all three classifications have poor predictive ability for renal function outcome and mortality.

Background: The lumbar spinal canal consists of 5 interconnected lumbar vertebrae through which the final part of the spinal cord passes and the lumbar and sacral spinal nerves that form the cauda equina. The lumbar canal stenosis can directly affect neurological symptoms and pain in the lumbar region and lower extremities. Due to the frequency of such symptoms, lumbar stenosis has been the subject of research around the world. Objective: The objective of this study was to measure, analyze and compare the mediosagital and interpeduncular diameters of the lumbar spinal canal in the population of Bosnia and Herzegovina to other populations around the world. Methods: We conducted a retrospective descriptive study on patients (n=200) who underwent Multi-slice computer tomography (MSCT) performed on a 40-slice CT scanner (Siemens Somatom Definition AS) for lumbar pain between January 1, 2013 and December 31, 2014. Age, gender, midsagittal (MSG) and interpeduncular (IP) diameters of the lumbar spine were recorded for each patient. Results: Results of our study show that the largest MSG diameter is at L1 level for both sexes, with an average length of 19,06mm, and the smallest at L3 level, with an average length of 16,66mm. Our study shows that the MSG diameter is significantly larger in females than males on all levels from L1 to L5. In both sexes, MSG diameter shows the form of an hourglass with narrowing at L3 level. IPD is largest at L5 level for both sexes, with an average length of 31,94mm, and the smallest average length at L1 level, at 24,78mm. IPD diameter is significantly larger in males than females on all levels from L1 to L5. IPD shows a tendency of growth from L1 to L5 in both sexes. Conclusion: There were significant differences in the dimensions of the lumbar spine canal between female and male patients. We found significant difference in MSG and IP diameters measurements between Bosnian and Herzegovinian population compared to other populations. The dimensions of the lumbar canal provide a baseline of normative data for the evaluation of patients presenting with lower back pain and lumbar canal stenosis in study population.

Understanding the responses of animals to seasonal heat stress on the genomic level has led to the identification of genes implicated in thermal stress reaction mechanisms. In this study, the relative gene expression of Interleukin-10 (IL-10), an anti-inflammatory cytokine and biomarker for heat stress-mediated immune modulation, was observed during the summer and winter seasons in continental and tropical sheep breeds, namely, Hungarian Indigenous Tsigai and White Dorper, employing quantitative real-time polymerase chain reaction (qRT-PCR). Temperature-humidity indices (THI) were calculated to assess heat stress levels. The results indicate that IL-10 CT-values were significantly higher during the summer, when heat stress prevails, in both sheep breeds compared to winter. While the White Dorper exhibited a higher numerical value for the summer relative gene expression ratio (16.2) compared to the Hungarian Indigenous Tsigai (12.3), no significant differences in CT values were observed between breeds or among sexes. These findings suggest the immune-adaptive characteristics of the two sheep breeds during seasonal heat stress. The variation of IL-10 gene expression levels between the two breeds can be attributed to their geographical origins; the White Dorper emerging from arid subtropical South Africa and the Hungarian Indigenous Tsigai Sheep thriving in the seasonally harsh Carpathian climate for centuries.

The thermal energy sector is very important at this time of global energy transition. From the aspect of stable energy independence, this is especially important in countries whose energy system is based on fossil fuels, especially coal. This is why decarbonisation of the energy sector is necessary, with a partial and gradual substitution of coal with renewable fuels. However, the use of these fuels is not always possible in existing plants. This refers to the establishment of energy, economic and environmentally acceptable proportion of the co-firing of these fuels, i.e. a mixture of coal and renewable fuels. The success of the establishment of this process is a function of several variables, the dominant of which are the aggregate properties of the fuel, basic and their mixtures, including the ash properties of those fuels. With the motive of contributing to a more successful implementation of the energy transition in the thermal energy sector, and with the aim of obtaining new scientific knowledge about the characteristics of the combustion of lignite and brown coal with different renewable fuels, laboratory research was carried out. In particular, different mixtures of lignite and brown coal, waste woody biomass and Miscanthus as a fast-growing energy crop were subjected to co-firing with variable process conditions. In addition to changing the composition of fuel mixtures, the test regimes included a significant change in process temperature (1250-1450 °C) and the primary measure of staged air supply to the furnace. In these combustion conditions, the emission of undesirable and harmful components into the environment, the efficiency of combustion, and the tendency of the ash from the fuel mixture to possible soiling of the heating surfaces in the furnace were evaluated - an analysis of the characteristics of the ash samples from the reaction zone and samples of the slag and ash to the furnace. Here, in both cases of co-firing, lignite and brown coal with different types of biomass, it was shown that in real conditions it is possible to establish a sustainable primary energy conversion process from fuel with a low unburnt carbon content in the slag (unburnt carbon content, UBC<1%) as well as low CO emission, below 350 mg/mn 3. At the same time, the NOx emission is below 320 mg/mn 3 during the co-firing of lignite mixtures at 1250 °C, and in the case of brown coal mixtures below 740 mg/mn 3 at 1450 °C. In both cases, the net CO2 emission decreases in proportion to the proportion of biomass in the mixture, while the SO2 emission is still high, at a level of up to 2500 mg/mn 3 for lignite mixtures and up to 6400 mg/mn 3 for brown coal mixtures. None of the treated types of biomass, up to the level of applicable content in the mixture with lignite and brown coal, does not worsen the progress of the process from the aspect of possible slagging/fouling heating surfaces in the boiler.

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