Background and purpose 40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome. Materials and Methods Multicentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0–2). Results In the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02–1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27–3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41–1.24]) nor bridging IVT (aOR 1.08 [0.67–1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24–2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92). Conclusion Bridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT. Registration clinicaltrials.gov; Unique identifier: NCT03496064.

Aim To investigate analgesic and side effects of different doses of fentanyl in combination with propofol for colonoscopy. Methods This prospective randomized double-blind study conducted between 2019 and 2020 included 64 patients. Patients were randomized: Group 1 (fentanyl 0.5 μg/kg) and Group 2 (fentanyl 1.0 μg/kg) both in combination with propofol. Ramsay sedation score (RSS) was obtained at 5 with an additional dose of propofol. The primary outcome was the patient's postprocedural pain and adverse events during and after the procedure. Results The RSS means were statistically lower for Group 2 at the beginning and every 5 minutes of the procedure. Mean arterial pressure (MAP) for Group 2 (first, 5, 25 and 30 min) was significantly lower (p=0.000, and heart rate (HR) was significantly higher for Group 1 (during the entire procedure) (p=0.000) than in another group; peripheral oxygen saturation (SpO2 ) was significantly lower for measurements within both groups (Group 1, 5, 10, 15 min; Group 2, 5, 10,15 min) (p=0.000 and p=0.000, respectively). Anxiety (p=0.010), weakness (p=0.000) and confusion (p=0.023) proved to be significantly higher for Group 1, and hypotension (p=0.001) for Group 2 than in another group. No statistical significance of Visual Analogue Pain Scale (VAS) (p=0.501) and Aldrete recovery score (ARS) (p=0.845) was found. Conclusion There was no significance in postprocedural abdominal pain between the group of patients administered fentanyl at a dose of 0.5 μg/kg and the group of patients administered fentanyl at a dose of 1.0 μg/kg; however, prevalence of complications was more significant in the group with a fentanyl at a dose of 0.5 μg/kg.

Objective The imbalance of antioxidants and pro-oxidants plays a crucial role in the carcinogenesis of bladder cancer (BC). This study aimed to evaluate serum antioxidant status in patients with BC and determine its potential use in the diagnosis and progression potential considerations following histopathological assessment. Methods A cross-sectional study included 90 patients with BC, divided into Ta, T1, and T2–T4 stage subgroups, and according to cancer progression potential, into low-grade (LG) and high-grade (HG) subgroups. The control group (CG) included 30 healthy volunteers. Antioxidant status was determined using the spectrophotometric method and standard laboratory tests. Results Serum superoxide dismutase activity was significantly higher in BC patients regarding cancer stage in comparison to the CG (p<0.001). Catalase activity was highest in T2–T4 subgroup and was significantly higher compared to the Ta (p<0.01) and T1 (p<0.05) subgroups. Serum albumin level was significantly lower in the BC group compared to the CG (p<0.001). In addition, it was significantly lower in T2–T4 subgroup compared to T1 and Ta subgroups (p<0.01). A significant negative correlation was found between tumor size and serum albumin level only (r=−0.386, p<0.01). Catalase activity was higher in HG subgroup (p=0.009), while bilirubin level was higher in LG subgroup (p=0.035). The optimal cut-off value of catalase activity in differentiating patients with LG and HG BC subgroups was ≥11.96 IU/L, and the specificity and sensitivity were 51.1% and 82.2%, respectively. Bilirubin level, for a calculated optimal cut-off value of ≥11.95 μmol/L, had a specificity of 44.1% and sensitivity of 80.0%. Conclusion More invasive stages of BC with greater progression potential are associated with an increase in enzymatic antioxidant activity and a decrease in non-enzymatic antioxidant capacity. It may suggest a possible role of antioxidants in the prediction and monitoring of illness trajectory.

Aim To investigate infl uence of neutrophil-to-lymphocyte ratio (NLR) and proatherogenic risk factors to improve the accuracy of pneumonia severity index (PSI) in the prediction of community acquired pneumonia (CAP) outcome in healthy individuals. Methods A retrospective observational cross-sectional study conducted at the Clinic for Pulmonary Diseases and Tuberculosis "Podhrastovi", University Clinical Centre Sarajevo, included 83 patients with the diagnosis of CAP during the period March 2019-March 2021. Once diagnosed with CAP, PSI score was calculated and according to its value the need for hospital treatment was identifi ed. Patients were divided in two groups: low risk of CAP (PSI <90), and high risk of CAP (PSI> 90). Results The overall average hospital stay was 22.76±10.154 days. In the patients diagnosed with CAP, a positive correlation was established between the following parameters PSI score and age (r=0.670; p<0.01), C-reactive protein-CRP (rho=0.287; p<0.01), leukocytes (rho=0.406; p<0.01), NLR (rho=0.313; p<0.01) and platelet to lymphocyte ratio (PLR) (0.296; p<0.05). CRP, leukocytes, NLR and PLR were statistically signifi cantly higher in patients with high risk of CAP compared to patients with low risk of CAP. Diastolic blood pressure, lymphocytes, eosinophils were signifi cantly lower in patients with high risk of CAP (p<0.05;) compared to patients with low risk of CAP (p<0.01). The optimal cut-off value of NLR for CAP patients was 3.089 with an estimated area under curve (AUC) of 0.664. Conclusion Proatherogenic parameters such as age, systolic blood pressure and leukocytes in combination with neutrophil-lymphocyte count ratio could improve accuracy of the pneumonia severity index in community acquired pneumonia outcome.

Background: Conflicting data exist on traditional lipid profiles in patients with Alzheimer’s disease (AD) and vascular dementia (VD), whereas scarce number of studies evaluated non-traditional lipid profiles in patients with AD and VD. Studies have shown that ethnic background may affect lipid profile. Objective: The aim of the present study was to conduct comparative assessment of traditional and non-traditional lipid profiles in Bosnian patients with AD and VD. Methods: A controlled, cross-sectional study was performed with 66 patients with AD, 50 patients with VD, and 60 control subjects. The Montreal Cognitive Assessment (MoCA) test was used for an evaluation of the global cognitive function. The Hachinski ischemic score was used to distinguish patients with VD from those with AD. Plasma total cholesterol (TC), high-density lipoprotein -cholesterol (HDL-C), and triglycerides (TG) levels were determined using standard enzymatic colorimetric techniques, whereas the Friedewald formula was used to calculate low-density lipoprotein-cholesterol (LDL-C) levels. The non-traditional lipid indices such as TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratio were separately calculated. The differences between the groups were analyzed with ANOVA followed by the Tuckey posthoc test or with the Kruskal Wallis test followed by the Mann-Whitney test. Results: Results of the present study have shown that patients in AD group had significantly lower level of TC, TG, LDL-C, VLDL-C, Non-HDL-C and significantly lower atherogenic index compared to the control group (CG) and compared to the VD patients. Significant difference in values of TG and VLDL-C was observed between VD and the CG, whereas no significant difference in values of TC, LDL-C, atherogenic index and Non-HDL-C was observed between these two groups. Our results have also shown that TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were significantly lower in AD patients compared to the VD and CG. Moreover, TG/HDL-C ratio was significantly lower in VD compared to the CG. However, a significant difference in TC/HDL-C and LDL-C/HDL-C was not observed between VD and the CG. Conclusion: Based on the results of the present study it can be deduced that there is a difference in traditional and non-traditional lipid profiles between AD and VD patients of Bosnian descent. Obtained results suggest that lipids are decreased in AD and in VD to a certain extent. However, since there is an inconsistence in literature whether there is an association between cholesterol and cognition, large prospective studies are required to elucidate this controversy.

Vehicle automation and connectivity bring new opportunities for safe and sustainable mobility in urban and highway networks. Such opportunities are however not directly associated with traffic flow improvements. Research on exploitation of connected and automated vehicles (CAVs) toward a more efficient traffic currently remains at a theoretical level, and/or based on simulation models with limited reliability. Furthermore, testing CAVs in the real world is still costly and very challenging from an implementation perspective. A possible alternative is to use automated robots. By designing and testing both the low- and the high-level controllers of CAVs, it is indeed possible to reach a better understanding of the challenges that future vehicles will need to face. Robotic applications can effectively test these challenges within a wide variety of research communities—for example, via robotic competitions. Along this direction, the Joint Research Centre has organized the first European robotic traffic competition for automated miniature vehicles. Each team participated with four robots and was judged based on a set of indicators that assess the collective behaviors of the vehicles. Results show the suitability of the methodology with different teams proposing completely different approaches to deal with the challenge and thus achieving different results. Future competitions may further raise awareness about the possibility of using CAVs to improve traffic and to engage with a broader community to design systems that are really capable of achieving this goal.

The 2022 World Health Organization (WHO) classification of the urinary and male genital tumors was recently published by the International Agency for Research on Cancer. This fifth edition of the WHO "Blue Book" offers a comprehensive update on the terminology, epidemiology, pathogenesis, histopathology, diagnostic molecular pathology, and prognostic and predictive progress in genitourinary tumors. In this review, the editors of the fifth series volume on urologic and male genital neoplasms present a summary of the salient changes introduced to the classification of tumors of the prostate and the urinary tract.

Nonlinear handheld detection of magnetic nanoparticles is used to assess the lymph node status of cancer patients. Joint sensitivity and resolving power of nonlinear handheld detection can be maximized by optimizing the frequency of the excitation field, which is strongly influenced by Brownian and Néel relaxation. The characteristic frequency of magnetic nanoparticles that defines sensitivity and resolving power is usually assessed by AC susceptometry. In this study, we used SPaQ data to predict handheld detection performance for magnetic nanoparticles with various particle sizes. SPaQ assesses dynamics by measuring the derivative of the magnetization originating from magnetic nanoparticles activated by an alternating excitation field. The ratio between the maximum signal difference and full-width-at-half-maximumis used to estimate the optimal excitation frequency. Thereupon, it was shown that a particle with a combination of Brownian and Néel relaxation is superior in nonlinear handheld detection compared to Brownian or Néel only particles. Moreover, the optimal excitation frequency is generally established at a slightly higher frequency compared to the characteristic frequency assessed by AC susceptometry. Consequently, this insight into the consequences of the dynamic behavior of magnetic nanoparticles under an alternating magnetic field enables the optimization of nonlinear handheld detection for specific clinical applications.

Obstetric shock (OS) has been defined as a life-threatening cardiovascular collapse syndrome associated with pregnancy, childbirth and puerperium (obstetrics causes), and is the most significant cause of high maternal mortality (MM) throughout human history. Shock in obstetrics (SIO) refers to indirect causes of non-obstetrics causes in pregnancy, childbirth and puerperium (polytrauma, aesthetic incidents, cardiovascular or cerebrovascular incidents, other septic syndromes). The goals of OS treatment are: to quickly detect the location or cause of bleeding / injury / inflammation, prevent the progression of shock, prevent massive transfusions, preserve the uterus (and adnexa), and preserve fertility if possible. Surgical treatment of septic shock includes exploratory laparotomy (laparoscopy), ectomy or resection of the necrotized organ, abdominal lavage with multiple drainages, continuous peritoneal drainage with lavation, extensive triple antibiosis per admission or per antibiogram and thromboprophylaxis. OS seems to remain a permanent miasma in practical clinical obstetrics, which we will not be able to influence, because we have obviously caused today's increase in MM from haemorrhagic OS by iatrogenic increase in the number of caesarean sections, especially elective ones.

Aim To investigate bystanders' CPR involvement in out-of-hospital cardiac arrest (OHCA) events, their current knowledge regarding OHCA and BLS measures, their willingness to learn BLS measures with the usage of AEDs, as well as current practices. Methods This cross-sectional study included: data regarding all OHCA events treated at the Emergency Medical Service of Canton Sarajevo between January 2015 and December 2019, and an online anonymous questionnaire that examined knowledge, attitudes and practices regarding basic life support (BLS) and automated external defibrillators (AEDs). Results A total of 328 (24.0 %) of 1362 OHCA events achieved the return of spontaneous circulation (ROSC). OHCA incidence was 62/100.000 inhabitants per year. Male gender (p=0.043) and younger age (p<0.001) were significantly associated with obtaining ROSC. Only 44 (3.2%) OHCA events were assisted by bystanders, who were mostly medical professionals 38 (86.4%), followed by close family members 6 (13.6%). There was no report of AED usage. BLS and AED knowledge test score was in the range 12.0-89.8% with generally poor knowledge. Our residents agreed that BLS measurements are essential, 1604 (86.7 %) and that BLS should be a part of their curriculum, 1678 (90.7 %). Conclusion The prevalence of OHCA events in Bosnia and Herzegovina is similar to the region; ROSC among OHCA events was lower than European average, but among highest in the region. There was an extremely low rate of bystander engagement and no AEDs usage. Governmental institutions and health agencies should intervene to increase population knowledge thus increasing OHCA survival rate.