bluuebunny/crossref_metadata_2025 huggingface dataset:
Secretome of hypoxia-preconditioned mesenchymal stem cells enhance the expression of HIF-1a and bFGF in a rotator cuff tear model
Authors: Alif Iffan , Amalina Nur Dina , Nazar Muhammad Ariq , Fredianto Meiky , Herman Herry , Dias Ismiarto Yoyos , Putra Agung
Published: April 2024

Aim
To determine the effect of secretome hypoxia mesenchymal stem cells (SH-MSCs) on the relative gene expression of hypoxia inducible factor-1a (HIF-1a) and basic fibroblast growth factor (bFGF) in accelerating histomorphometric repair of tendon to bone interface healing in rats acute rotator cuff tear (RCT) model.
Methods
This is experimental research with posttest control group design. Thirty-male Wistar rats were divided into five treatment
groups: healthy group and rotator cuff reconstruction group included four groups: SH-MSCs W2 (the treatment group was given a SH-MSCs 0.5 mL and terminated at weeks 2), NaCl W2 (the control vehicle group was assigned NaCl 0.5 mL and terminated at weeks 2), SH-MSCs W8 (the treatment group was given a SHMSCs 0.5 mL and terminated at weeks 8), and NaCl W8 (the control vehicle group was given NaCl 0.5 mL and terminated at weeks 8). All the rats were terminated on day termination and HIF-1a and bFGF gene expression were analysed using qRT-PCR.
Results
SH-MSCs significantly increased the HIF-1a and bFGF gene expression than the NaCl group even in week 2 and week 8.
The highest increased gene expression of HIF-1a and bFGF was on week 8.
Conclusion
SH-MSCs are important in the healing repair process of the tendon-to-bone interface in acute RCT model rats through
increasing gene expression of HIF-1α and bFGF.
Association between shift work and extended working hours with burnout and presenteeism among health care workers from Family Medicine Centres
Authors: Pranjić Nurka , Mosorović Nehra , Bećirović Sabina , Sarajlić- Spahić Selvedina
Published: April 2024

Aim
To investigate the influence of irregular shifts on increased emotional, physical, and cognitive exhaustion and decreased working performance expressed by the phenomenon of presenteeism.
Methods
The study sample of 405 healthcare workers from Family medicine centres completed questionnaires in two measurement time points, in 2014 (TP1) and repeated in 2019 (TP2), when 301 respondents remained in the study. Healthcare workers completed questionnaires assessing demographics, work schedules, job burnout, and presenteeism.
Results
Repeated long-term exposure to rotating day-evening shifts was a significant risk for increased presenteeism (OR=1.689,
95%CI 1.042-2.739; p=0.001) and burnout (OR=1.705, 95%CI 1.237-2.352; p=0.001). Extended working hours are a predictor of presenteeism (OR=1.989, 95%CI 1.042-2.739; p=0.008).
Conclusion
The adverse effects of rotating day-evening shifts
on burnout and presenteeism among healthcare workers in a family medicine centre was little researched, particularly the issue of managing the risks of exposure to rotating day-evening shifts and extended working hours. This study reflects a situation of uncertainty, in which the logic of precaution is imposed on mental health, and keeps working engagements in health care workers. Appropriate management of shift work and better organization of work schedules in the primary healthcare sector protects the wellbeing of healthcare workers and patients, efficient work, and quality of health care, and invites for future research on better working schedules and introducing preventive interventions with available
flexibility of working times.
Hypoxic mesenchymal stem cells (MSCS)-induced interleukin (IL)-10 alleviate systemic lupus erythematosus (SLE) infl ammation through inhibiting interferon (IFN)-gamma production
Authors: Wisnu Prajoko Yan , Putra Agung , Prasetio Ardi , Dina Amalina Nur
Published: April 2024

Aim
To determine the eff ect of hypoxic mesenchymal stem cells (MSCs) on the interleukin (IL)-10 and interferon (IFN)-gamma in peripheral blood mononuclear cells (PBMCs) from systemic lupus erythematosus (SLE) patients.
Methods
This study used a post-test control group design. Hypoxic MSCs were isolated and characterized according to their surface marker expression and diff erentiation capacities. PBMCs isolated from SLE patients were divided into three groups: control and two treatment groups. The treatment groups were treated by co-culturing MSCs to PBMCs with a ratio of 1:10 (T1) and 1:1 (T2) for 48 h incubation. Furthermore, IFN-gamma and IL-10 levels were determined by cytometric bead array (CBA) fl ow cytometry.
Results
Hypoxic MSCs signifi cantly decreased the IFN-gamma levels and increased the IL-10 levels in dose-dependent manner
compared to the control group. The highest activity of hypoxic MSCs was noticed in T2 group.
Conclusion
Hypoxic MSCs- induced IL-10 are important in the control of anti-infl ammatory eff ect on SLE through inhibiting IFN-gamma. 
The effects of two fixation methods on blood loss in patients with trochanteric fracture: dynamic hip screw vs. proximal femoral nail anti-rotation
Authors: Sivro Mirza , Lazović Faruk , Omerović Ðemil , Papović Adnan
Published: April 2024

Aim
The two most commonly used implants for treatment of trochanteric fractures are the dynamic hip screw (DHS) and proximal femoral nail antirotation (PFNA). The aim of this study was to evaluate blood loss in patients with trochanteric fracture treated with DHS or PFNA.
Methods
This retrospective comparative study included 61 patients with trochanteric fracture, who were divided according to a surgical method into DHS and PFNA groups. In the PFNA group, a short third generation gamma-nail was used for osteosynthesis (Supernail GT, Lima Corporate, Italy), and in the DHS group a dynamic hip screw was used (Synthes, Oberdorf, Switzerland). Complete blood count with haemoglobin and haematocrit values was taken preoperatively and on the first day postoperatively and a number of red blood cell transfusions (RBC) were evaluated. Electronic medical
records from 2022 were used to collect patient data.
Results
There were no significant differences in terms of gender and age between the groups (p=0.510 and p=0.087, respectively), as well as in the fracture type distribution (p=0.886). The duration of postoperative hospitalisation was similar between the groups (p=0.643). There was no statistically significant association between the number of RBC transfusions and fixation method (p=0.091), as well as in postoperative haemoglobin and haematocrit levels between the groups (p=0.180 and p=0.225, respectively).
Conclusion
Both DHS and PFNA implants are safe surgical techniques for the treatment of trochanteric fractures, with similar blood loss, number of blood transfusions and hospital stay.
Frequency of sweet and salty snack consumption among children in relation to their mothers' education level
Authors: Lisičić-Konaković Mirela , Mesihović-Dinarević Senka , Bajrić Elmedin , Jurišić Sanja , Musa Trolić Ines , Ćubela Mladen , Šarac Zdenko , Zukanović Amila
Published: April 2024

Aim
To investigate the frequency of consumption of sweet and salty snacks among children aged 2-18 years in relation to their
mothers’ education level.
Methods
A descriptive epidemiological study was conducted in five dental practices at the School of Medicine of the University of
Mostar from May to October 2022. The data were collected from medical records.
Results
Out of a total of 477 children, 172 (36.1%) had mothers with a high school education, while 305 (63.9%) had mothers with
a university degree. In the group of preschool children (aged 2-6 years), there were 42 mothers with high school education and 105 with university degree. In the group of school children (age 7-18 years) there were 130 mothers with high school education and 200 with university degree. The difference in the consumption of sweetened beverages among children of mothers with high school and university was not statistically significant. Similar results were
found for the consumption of salty snacks, lollipops, caramels and candies. The frequency of the consumption of biscuits, chocolate and cakes (several times a day) was statistically significantly higher among the children of mothers with high school education (p=0.04), especially among school children. Eating habits of children, regardless of the level of education of their mothers, differed significantly only in the consumption of lollipops, caramels, and
candies (p=0.03), which were consumed once a day by 79 (63.7%) schoolchildren and 45 (36.3%) of pre-schoolers.
Conclusion
A higher level of education among mothers does not necessarily equate to proper nutritional knowledge.
Red blood cell distribution width as a predictor of outcome in Intensive Care Unit: a retrospective cohort study
Authors: Ljuca Asmira , Rizvanović Nermina , Ljuca Senad , Jahić Alma
Published: April 2024

Aim
To evaluate the predictive significance of the red blood cell distribution width (RDW) >14.5 at admission to the Intensive
Care Unit (ICU) on outcome parameters: length of hospital stay (LOHS), incidence of hospital mortality, 30-day mortality and 30-day survival after hospital discharge in unselected (surgical and non-surgical) critically ill patients.
Methods
A total of 325 surgical and non-surgical critically ill patients were divided based on the RDW value at admission to the
ICU into two groups: Group 1 (RDW >14.5) and Group 2 (RDW≤14.5). Demographic and clinical parameters, laboratory findings, treatment and outcome parameters were compared between the groups. The predictive significance of RDW>14.5 on outcome parameters was analysed using linear regression analysis and univariate and multivariate logistic regression analysis, as appropriate.
Results
In Group 1, LOHS was higher (19.77±15.15; p<0.000) as was the prevalence of hospital mortality (46.6%; p<0.0523),
while 30-day survival after hospital discharge was lower (52.9%; p>0.026) compared to Group 2. RDW >14.5 was positively linearly related (r=0.64; r2=0.40; p=0.000) with LOHS. RDW >14.5 predicted the prevalence of in-hospital mortality with a 73.7% positive predictive value (AUC 0.62; sensitivity 70.1%; specificity 59.5%; p<0.05) and 30-day survival after hospital discharge with a 34.5% negative predictive value (AUC 0.45; sensitivity 58.3%;
specificity 68.7%; p<0.05).
Conclusions
RDW value >14.5 at admission to the ICU can predict prolonged hospital stay, higher mortality and lower survival
rate. RDW >14.5 may be an inexpensive and widely available early warning to redirect diagnostic and therapeutic decisions and improve outcomes.
Cement extravasation as a complication for kyphoplasty and vertebroplasty procedure: a retrospective analysis of 171 cases
Authors: Jarrar Sultan , AL Barbarawi Mohammed M. , Daoud Suleiman S. , Jaradat Amer , Alkalban Rand , Abu Qayyas Layan , Alabdallah Nadeem B. , Khurfan Basel W. , Al Barbarawi Ala’ M. , Audat Ziad A.
Published: April 2024

Aim
Kyphoplasty and vertebroplasty are minimally invasive procedures used in bone augmentation following vertebral fractures when conservative management has failed. Cement injection could leak into surrounding structures leading to post-operative sequelae, which could be symptomatic. This study compared the rate and site of cement extravasation in vertebroplasty, kyphoplasty, and a combined approach. The indications, aetiology, and factors influencing results and the effect of screws were considered.
Methods
 A retrospective descriptive study of 171 patients was conducted between 2009 and 2021. Only 89 patients had available
imaging. The site of cement extravasation was evaluated postoperatively by CT-scan and X-ray.
Results
There was a statistically significant difference in the prevalence of cement extravasation between kyphoplasty and vertebroplasty procedures (p=0.004). Age and gender had no significant influence on the rate of cement extravasation. Patients who underwent kyphoplasty had the lowest rate of cement extravasation (46.9%) compared to vertebroplasty (85.2%) and the combined approach (69.2%). The most common site of leakage was in perivertebral veins (37.9%). The use of screws did not indicate a greater risk of cement leak (p=0.652). Bone metastases were the aetiology with the highest cement leakage rate (27.5%).
Conclusion
The use of kyphoplasty alone or in conjunction with vertebroplasty decreases the risk of cement extravasation and subsequent complications compared to vertebroplasty alone. The use of pedicle screws appears to be safe and was not found to increase the risk of cement extravasation.
Tracheostomy in COVID-19 patients and its effect on laboratory parameters: a retrospective case series
Authors: Krkalić Amel
Published: April 2024

Aim
To evaluate characteristics of COVID-19 tracheostomy and its effect on laboratory parameters.
Methods
Demographic parameters, duration indicators, and laboratory parameters before and after tracheostomy were analysed in
a series of 17 patients with COVID-19 patients.
Results
Of the 17 patients, four were males and 13 females with a mean age of 59 years. The average length of total hospitalization was 12 days, the length of stay in intensive care was 10 days, the length of endotracheal intubation was 9 days; tracheostomy was mostly performed on the seventh day. There was a significant correlation between comorbidities and outcomes; however, laboratory parameters did not show statistical significance.
Conclusion
Open surgical tracheostomy is recommended in all COVID-19 critically ill patients within 1 or 2 weeks after endotracheal intubation; it can be performed in terms of renal laboratory parameters, lactate and D-dimer. These patients had a lower
possibility of weaning from mechanical ventilation.
Comparison of postoperative bleeding using harmonic scalpel and LigaSure in thyroid surgery: a 15-year single-centre retrospective study
Authors: Mulita Francesk , Theofanis George , Verras Georgios-Ioannis , Liolis Elias , Papanikos Vasileios , Tchabashvili Levan , Tasios Konstantinos , Iliopoulos Fotios , Tsilivigkos Christos , Kehagias Dimitrios , Kaplanis Charalampos , Antzoulas Andreas , Samaras Angelos , Drakos Nikolas , Panagiotopoulos Ioannis , Leivaditis Vasileios , Filis Dimitrios , Maroulis Ioannis , Bouchagier Konstantinos , Michalaki Marina
Published: April 2024

Aim
Thyroidectomy is the most common operation in the field of endocrine surgery. The aim of this study was to compare the use of LigaSure vessel (LS) and harmonic scalpel (HS) in 1653 total thyroidectomies between January 2008 and March of 2023, with regards to analysis of surgical bleeding complications duration the hospital stay and operative surgical time.
Methods
It is a retrospective analysis of a prospectively maintained database. Patients have been categorized into two groups:
Group A included 718 patients from January 2008 to May 2013 when LS was used, and the Group B included 935 patients from June 2013 to March 2023 when HS was used.
Results
From the total of 14 postoperative bleeding cases that occurred in patients of Group A, only in 4 of them it was necessary
to have a reoperation. The other 10 cases involved minor haemorrhages, while from the total of 6 postoperative bleeding cases that happened to patients of Group B, there were 4 cases that needed a reoperation (p-value >0.05) and 2 patients with minor haemorrhages. The postoperative evaluation of minor bleedings revealed statistically significant differences between the two groups (p-value < 0.05). The average hospital stay was similar in the two groups.
Conclusion
Both devices exhibit identical safety profiles in thyroidectomies specifically regarding major bleeding complications
that require reoperation. Additionally, HS was found to be more effective at achieving haemostasis, especially in the subgroup of patients with thyroid carcinoma. The results of the present study may be useful for high-volume centres performing numerous thyroidectomies every day.
A correlation of demographic characteristics, preoperative conservative therapy and timing with postoperative outcome in herniated disc-associated cauda equina syndrome: Do they really matter?
Authors: Bečulić Hakija , Begagić Emir , Skomorac Rasim , Jusić Aldin , Efendić Alma , Selimović Edin , Mašović Anes , Bečulić Lejla
Published: April 2024

Aim
To examine a correlation of demographic characteristics of patients, preoperative modality of conservative therapy and timing on the postoperative outcome of patients six months after the operation.
Methods
A retrospective, non-randomized, clinical study involved 48 patients of different age and gender with a verified diagnosis of
cauda equina syndrome (CES). The inclusion criteria were patients with CES caused by discus hernia. Observed research variables were age, gender, affected vertebral level, conservative modalities of perioperative therapy (nonsteroidal anti-inflammatory drugs - NSAIDs and physiotherapy), duration of symptoms, and outcome parameters (motor and sensory function, sphincter function of the urinary bladder and bowel).
Results
A statistically significant negative correlation was found between age and postoperative outcome (p<0.05). The affected
vertebral level was positively correlated with the motor and sensory outcome (p<0.05). A positive correlation between the use of NSAIDs and the outcome was found (R=0.570; p<0.001), as well as a negative correlation with perioperative physiotherapy (R=-0.201; p= 0.001). Postponement of surgery was negatively correlated with outcome variables (p<0.001).
Conclusion
The results of the study bring new conclusions that
were not previously observed. Possible new characteristics associated with the outcome of cauda equina syndrome were determined.
Correlation of localization and size of the parathyroid glands by ultrasound and intraoperative findings in hyperparathyroidism
Authors: Uščuplić Sabrina , Umihanić Šekib , Altumbabić Hasan , Salkić Almir , Kasumović Merima , Ramaš Almedina
Published: April 2024

Aim
To determine a correlation between the localization of the parathyroid gland (PTG), based on ultrasound (US) examination and the operative findings, as well as the correlation between the size of the parathyroid glands measured by ultrasonography (USG) with pathological findings+, and prevalence of enlarged parathyroid glands in various forms of hyperparathyroidism.
Methods
 A total of 83 patients with hyperparathyroidism who had undergone parathyroidectomy over a period of seven years
were included in the study. US examinations of the neck and scintigraphy were performed before surgery in 83 and 42 patients, respectively. In the pathohistological analysis, in addition to diagnosis, the size and weight of the parathyroid gland were measured.
Results
US examination revealed 125 enlarged parathyroid glands and two normal-sized glands. Scintigraphy revealed 52 enlarged and three normal-sized parathyroid glands. Enlarged parathyroid glands were more frequently found in the projection of the lower pole thyroid glands. A significantly higher number of enlarged upper parathyroid glands were found by the operative findings than by US. There was no statistically significant difference in the diagnosis of enlarged parathyroid glands in all three forms of hyperparathyroidism. There was a positive correlation between the
size of the parathyroid glands obtained by US and the size of the operative finding (κ=0.51; p=0.00 and p<0.0005, respectively). The relationship between parathyroid gland size measured by ultrasound and pathological analysis showed a positive correlation.
Conclusion
Ultrasound was useful in evaluating enlarged parathyroid glands, especially in combination with scintigraphy.
Breaking habits: safety and efficacy of elective electrocardioversion of atrial fibrillation and atrial flutter in the setting of day hospital
Authors: Brkić Ammar , Bećirović Minela , Bećirović Emir , Brkić Tarik , Brkić Esad , Mršić Denis , Bećirović Amir , Jašarević Amila , Softić Emir , Mujić Ibralić Alma
Published: April 2024

Aim
To examine safety and efficiency of electrocardioversion (EC) in elective treatment of atrial fibrillation and atrial flutter in
the setting of Day Hospital by determining success rate, frequency of adverse events and possible cost benefit compared to admitting a patient into hospital.
Methods
This prospective observational cohort study was performed in Day Hospital and in Intensive Care Department of Internal
Medicine Clinic, University Clinical Centre Tuzla from January 2019 to December 2022 and included 98 patients with a persistent form of atrial fibrillation (AF) or atrial flutter. The patients who were divided in two groups, 56 hospitalized and 42 patients accessed in Day Hospital. In all patients, medical history, physical examination, electrocardiogram (ECG) and transthoracic echocardiogram (TTE) evaluation was performed in addition to laboratory findings. Electrocardioversion was performed with a monophasic General Electric defibrillator in anterolateral electrode position with up to three repetitive shocks.
Results
In hospital setting group overall succes rate of electrocardioversion was 85%, with average 2.1 EC attemps, there was with one fatal outcome due to stroke, one case of ventricular fibrillation (VF) due to human error, and 6 minor adverse events; with average cost of was 1408.70 KM (720.23 €) per patient. In Day Hospital setting succes rate was 88%, with average 2 EC attempts, no major adverse events, 8 minor adverse events; and average cost was of 127.23 KM (65.05 €) per patient.
Conclusion
Performing elective electrocardioversion in Day Hospital setting is as safe as admitting patients into hospital but substantially more cost effective.
Prognostic value of a predictive score based on functional parameters for clinical outcome in patients with decompensated cirrhosis of the liver
Authors: Mujkanović Jasminka , Ljuca Kenana , Tursunović Amir , Ljuca Nadina , Džananović Dževad , Ljuca Farid
Published: April 2024

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.
Functional gastrointestinal disorders in children: a single centre experience
Authors: Selimović Amela , Mekić Nina , Terzić Selma , Ćosićkić Almira , Zulić Evlijana , Mehmedović Majda
Published: April 2024

Functional gastrointestinal disorders in childhood (FGIDs) constitute a significant time-consuming clinical problem for healthcare practitioners, and they carry an important psychosocial burden for patients and their families. The aim of this study was to characterize etiology, clinical features, and interventions in a paediatric cohort of patients with FGIDs, who were referred to a tertiary care university-affiliated centre.
Methods
A retrospective study of children aged 1-15 years old referred to the Clinic for Children’s Diseases, University Clinical
Center Tuzla, from January 2022 to December 2022, who fulfilled criteria for FGIDs (n=209), were divided in three groups: 0-3, 4-10 and 11-15 years old. Demographic characteristics, number of examinations, duration of symptoms, initial diagnosis, hospital evaluation and outcomes of each child were collected.
Results
During the study period, 670 patients were referred to a
gastroenterologist, out of whom 209 (31.2%) fulfilled the criteria
for FGIDs, with median age of 8.0 years. Females were predominant in all groups (p=0.0369). Children aged 4 to 10 years were significantly more frequent (p<0.0001). A median duration of symptoms was one year. Functional constipation was the most common diagnosis, 99 (47.4%), followed by functional abdominal pain not otherwise specified, 67 (37.2%), and functional dyspepsia, 25 (12.0%). Fifty-two percent of patients did not require further follow-up by the gastroenterologist.
Conclusion
Although FGDIs are frequent, they are not well accepted neither among patients nor physicians. Extensive diagnostic
procedures are often unnecessary and the cessation of specialized care follow-up is possible in a significant number of cases.
Morphometric and Ki-67 proliferative index-related characteristics of meningiomas and their correlation with demographic, clinical, histopathological, and postoperative features
Authors: Pugonja Ragib , Bečulić Hakija , Begagić Emir , Skomorac Rasim , Selimović Edin , Moranjkić Mirza
Published: April 2024

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.
Comparative assessment of high-risk cardiovascular medication knowledge between practising and student nurses: a descriptive multi-centre study
Authors: Taslim Najla , Turikham Alghamdi Amal , Ali Alqarni Dana , Rashid Shaista , Edge Dustin Todd
Published: April 2024

Aim
To examine unexplored knowledge of cardiovascular highrisk medications and perception thereof among practising nurses
and students in the Kingdom of Saudi Arabia (KSA).
Methods
The multicentre cross-sectional quantitative study used an online survey dichotomised into a knowledge test (true/false
and multiple choice questions) and a perception assessment (closed-ended questions). Four hundred and eighteen nurses participated in the study.
Results
In the knowledge test, 19 (4.5%) participants scored high (≥71%), while 83 (19.8%) and 316 (75.5%) demonstrated moderate (score ≥51-70%) and poor performance (score ≤50%), respectively. In a comparative analysis, the knowledge level of staff nurses was significantly higher than the students but not the other
nurses’ cohort. Nurses' specialty and region of KSA were strongly associated with the knowledge level. Emergency room nurses and those belonging to the eastern region of KSA exhibited higher knowledge levels than other subgroups. A vast majority of nurses, 128 (30.6 %), rated their knowledge of medicines as somewhat sufficient, while quoting insufficient knowledge 226 (54.1%) as the major cause of medication errors. Three hundred and sixteen (75%) nurses expressed interest in undergoing specialised training in high-alert medication-based therapy preferably in a classroom
setting by 279 (66.7%).
Conclusion
This study revealed a marked knowledge deficit in high-risk cardiovascular drugs among nurses. The pharmacological curriculum in nursing schools should be tailored to be clinically oriented and reinforced with problem-based learning. Continued pharmacology education focusing on high-risk drugs should be implemented among nurses to safeguard patient lives by mitigating the risks of medication error. 
Prediction of pulmonary embolism and its complication in diabetes mellitus type 2: a 5-year retrospective study
Authors: Bošnjić Jasmina
Published: April 2024

Aim
To investigate the association between type 2 diabetes mellitus (T2DM) and pulmonary embolism, as well as to determine the prognostic value of troponin, D-dimer, prothrombotic, and proinflammatory markers in patients with T2DM.
Methods
The retrospective cohort study included 305 patients with pulmonary embolism, divided into two groups: the first group
with type 2 diabetes mellitus (n=165) and the control group without type 2 diabetes mellitus (n=140). Data were collected from May 2018 to May 2023. In all patients the following parameters were analysed: anthropometric parameters, laboratory parameters (troponin, D-dimer, CRP, fibrinogen, uric acid, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), arterial blood pressure, antiphospholipid antibodies, HOMA-IR index, CT angiography of the pulmonary artery, rate of adverse clinical events in pulmonary embolism (need for inotropic catecholamine
support, fibrinolysis, cardiopulmonary resuscitation) and the rate of intrahospital mortality from pulmonary embolism.
Results
Patients with T2DM had elevated troponin, D-dimer, CRP, uric acid, fibrinogen, HOMA-IR and more severe clinical
complications with higher mortality rates within 10 days of hospital admission. Significant predictors of PE in T2DM patients were found. Patients with pulmonary embolism in T2DM had a 4.38 times higher chance of death compared to patients with pulmonary embolism without T2DM.
Conclusions
Troponin, D-dimer, prothrombotic, and proinflammatory markers have good prognostic value for short-term
outcomes in PE among patients with T2DM
Availability and quality of primary health care in the compulsory health insurance system in Kazakhstan
Authors: Shurenova Makhabbat , Kurakbayev Kuralbay , Abildaev Tleukhan , Tazhiyeva Aigul
Published: April 2024

Aim
To evaluate patient satisfaction with primary healthcare services and determine effectiveness indicators within Kazakhstan's compulsory health insurance system.
Methods
An analytical observational study with cross-examination was conducted in Kazakhstan's primary healthcare (PHC) organizations. Patient satisfaction was assessed through a 35-item closed-question questionnaire. An analysis of stimulating component result indicators for per capital standard financing in PHC organizations based on their achieved outcomes was performed.
Results
Among surveyed patients, 54.0% (1.80±1.108) expressed complete satisfaction with medical care, while 59.4%
(1.82±1.269) perceived laboratory tests as readily accessible. Notably, males exhibited higher satisfaction levels with medical care and the availability of laboratory tests compared to females. The city polyclinics № 3 and № 14 in Almaty, Kazakhstan, achieved significant performance indicators, resulting in a 1.1-fold increase in the incentive component of per capital funding.
Conclusion
Within the framework of compulsory health insurance, primary healthcare organizations in Kazakhstan offer affordable and effective medical care, as attested by surveyed patients and the final result indicators of the polyclinics.
Vascularization of a bone stump
Authors: Shevchuk Viktor , Bezsmertnyi Yurii , Jiang Yankai , Branitsky Olexander , Bezsmertna Halyna , Bondarenko Dmytro
Published: April 2024

Aim
To study the character of blood circulation in the bone stump at tight and loose closure of the medullary cavity.
Methods
Two series of experiments on 39 rabbits with mid-third femoral amputation and muscular plasty were carried out. In the
1st (experimental) series, the bone scapula was closed by thin cortical autograft taken from the epimetaphyseal area, and then the muscles were sutured, and in the 2nd – the scapula was closed by myoplasty only. Follow-up periods: 1st series – 7, 14, 21 days and 1, 3, 6 months, 2nd series – 1, 3, 6 months. Histological methods with infusion of vessels with ink-gelatin mixture and morphometry was used.
Results
In the 1st series there was a rapid restoration of the disturbed macro- and microcirculation due to the reserve sources of
blood circulation and the development of extravascular ways of microcirculation. In the 2nd series, blood circulation recovery was significantly slower and occurred mainly due to the development of extravascular microcirculatory pathways.
Conclusion
The study established undeniable usefulness of tight closure of the bone marrow cavity during amputation.
Prevalence of familial hypercholesterolemia in patients with acute coronary syndrome
Authors: Dragila Željka , Lozert Matea , Canecki-Varžić Silvija , Selthofer-Relatić Kristina
Published: April 2024

Aim
To investigate the prevalence of familial hypercholesterolemia in patients with acute coronary syndrome (ACS).
Methods
The study included fifteen patients with first or repeated ACS and treated/nontreated dyslipidaemia admitted to the Department of Cardiovascular Diseases of Clinical Hospital Centre Osijek between 1 January 2020 and 1 January 2021. The cut-off value of low-density lipoprotein (LDL)-C was 4.5mmol/L as a possible cut-off value for familial hypercholesterolemia presence. Data were collected from medical history and during patient’s follow-up.
Results
Included patients that fulfilled criteria were predominantly male – 14 (93%), mean age 61 years. The median level of LDL cholesterol at admission because of ACS was 5.14 mmol/L, whereas the follow-up level after one year was 2.27 mmol/L (p=0.001). At first follow-up, 7 (46%) patients were treated with atorvastatin 80 mg or rosuvastatin 40 mg, 3 (20%) atorvastatin 80mg + ezetimibe 10mg, 2 (13%) with rosuvastatin 40 mg+ ezetimibe 10 mg, other patients were treated with a lower dose of statin or ezetimibe. According to LDL-C profile and by calculating the
Dutch Lipid Clinic Network Score, one (of 15) patient was categorized as having definite familial hypercholesterolemia and two (of 15) as having probable familial hypercholesterolemia leading to the use of triple hypolipidemic therapy (statin+ezetimibe+PCSK9 inhibitor) in 2 (13%) patients (one female and one male).
Conclusion
LDL-C level of 4.5 mmol/L and higher represents an indication for screening for familial hypercholesterolemia in patients with ACS. The prevalence of familial hypercholesterolemia in ACS, estimated by the Dutch Lipid Clinic Network Score, could be higher than previously reported.
Comparison of cutout risk factors between single- and doublescrew proximal nails in intertrochanteric femur fractures - a multicentric study
Authors: Colasuonno Giulia , Caiaffa Vincenzo , Solarino Giuseppe , Coviello Michele , Abate Antonella , Vicenti Giovanni , Ippolito Francesco , Nappi Vittorio , Abbaticchio Andrea Michele , Caiaffa Elio
Published: April 2024

Aim
Significant risk factors for femoral nail cutout are well-documented, primarily in the context of single-screw proximal nails.
However, it remains uncertain whether those same risk factors are applicable when considering different implant devices. The aim of this retrospective cohort study was to compare cutout risk factors between single- versus double-screw proximal femoral nails.
Methods
Patients over the age of 75 with intertrochanteric femur fractures (AO Classification 31-A1 or 31-A2) were included in the multicentre study. A study group was treated with a double-screw nail, while a control group received single-screw device. Demographic data, surgical time (min), fracture pattern, distal locking, reduction quality, comorbidities, tip-apex distance (TAD) and 12-month functional scores was collected.
Results
Two hundred patients were enrolled, 100 for each group.
Nine patients experienced a cutout complication, five in the study
and four in the control group. The main differences were in distal locking configurations (p<0.05) and in TAD values (p<0.05). The TAD value was higher in the study than in the control group (30.40±0.89 versus 26.79±1.79). No differences at 12-month follow up were reported according to functional scores.
Conclusion
This study provides insights into the choice of nail systems for intertrochanteric femur fractures, highlighting the importance of distal locking configurations and TAD values. The double screw nail exhibits quite a tolerance by having a higher
average TAD value. These findings may guide clinical decisionmaking in the treatment of this challenging fracture type.
A systematic evaluation of big data-driven colorectal cancer studies
Authors: Mohammad Eslam Bani , Ahmad Muayyad
Published: April 2024

Aim
To assess machine-learning models, their methodological quality, compare their performance, and highlight their limitations.
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were applied. Electronic databases Science Direct, MEDLINE through (PubMed, Google Scholar), EBSCO, ERIC, and CINAHL were
searched for the period of January 2016 to September 2023. Using a pre-designed data extraction sheet, the review data were extracted. Big data, risk assessment, colorectal cancer, and artificial intelligence were the main terms.
Results
Fifteen studies were included. A total of 3,057,329 colorectal cancer (CRC) health records, including those of adult patients older than 18, were used to generate the results. The curve's area under the curve ranged from 0.704 to 0.976. Logistic regression, random forests, and colon flag were often employed techniques. Overall, these trials provide a considerable and accurate CRC risk prediction.
Conclusion
An up-to-date summary of recent research on the use of big data in CRC prediction was given. Future research can be
facilitated by the review's identification of gaps in the literature. Missing data, a lack of external validation, and the diversity of
machine learning algorithms are the current obstacles. Despite having a sound mathematical definition, area under the curve application depends on the modelling context. 
Common inflammatory markers in the screening of knee arthroprosthesis infections
Authors: Conteduca Jacopo , Filipponi Marco , Pichierri Paolo , Casto Alberto , Meccariello Luigi , Rollo Giuseppe
Published: April 2024

Aim
 To evaluate the sensitivity and specificity of serum C-reactive protein (CRP) in early and late total knee arthroplasty (TKA)
infections.
Methods
 Blood tests to determine CRP levels (cut-off 10 mg/L) were conducted before surgery, at 1st day, 7th day and 15th day after surgery and at 1, 3, 6,12, 24 and 36 months. Patients had routine follow-up visits and radiological evaluations at 14 days and at 1, 3, 6, 12, 24 and 36 months. Infections were recorded and classified according to Widmer classification. The χ2 test or Fisher (in subgroups smaller than 10 patients) exact test was used to compare categorical variables. The statistical significance was set at p < 0.05.
Results
 A total of 19 infections were diagnosed during the followup. According to Widmer, five were classified as early post-operative and 14 as late chronic. All patients with early infections had suspected symptoms such as fever, swelling and pain. During the first month, 59 patients who had high CRP level but negative microbiological culture were considered as false positive representing a CRP sensitivity of 80% and a specificity of 67.6%. Fourteen patients had late chronic infection.
Conclusion
 This study suggests that a synovial fluid aspiration should be performed in patients with persistent inflammation
symptoms with or without radiographic signs of loosening. Moreover, it recommends the use of different serum and synovial tests for periprosthetic joint infection (PJI) diagnosis.
Effect of plateletpheresis on haematological values in voluntary donors: a retrospective data analysis over an eight-month period
Authors: Ahmetović-Karić Gorana , Ćatović-Baralija Elma , Mehić Kenan
Published: April 2024

Aim
To analyse changes in haematological values after plateletpheresis in donor population with regard to donor safety.
Methods
A retrospective study was conducted on first time and repeated healthy donors over a period of eight months in the Blood
Transfusion Institute in the Federation of Bosnia and Herzegovina in Sarajevo. A total of 75 plateletpheresis procedures performed using Amicus continuous flow cell separator were evaluated. Various pre- and post-donation haematological values were measured in all donors: haemoglobin concentration (Hb), haematocrit (Hct), red blood cell count (RBC), platelet count (PLT), white blood cell count (WBC), mean platelet volume (MPV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC).
Results
A significant decrease in post-donation Hb, Hct, RBC, PLT, MCHC (p<0.000) and WBC (p=0.003), and a significant
increase in MPV (p=0.011) and MCV (p<0.000) was found. Percentage reduction of haematological parameters Hb, Hct, RBC, PLT, WBC and MCHC decrease of 6.6%, 6.5%, 5.9%, 24%, 4.6% and 0.3%, respectively, in their respective count was noted postdonation. Eight (11%) donors had a post-procedure platelet count less than 150x10e9/L. Twenty two donors (29%) experienced mild side effects due to hypocalcaemia.
Conclusion
Plateletpheresis procedures are generally safe and well tolerated, without evident associated clinical manifestations
on healthy donors. 
The ion resonance and bromelain-vitamin C vs bromelainvitamin C to prevent ankle complications in post-operative bimalleolar surgery
Authors: Meccariello Luigi , Bello Anna Iolanda , Bove Giovanni , Gagliardo Nicola , Raffaele D’Anna , Matera Luigi
Published: April 2024

Aim
To investigate whether the use of ion resonance and bromelain-vitamin C or bromelain-vitamin C is the best to prevent ankle complications in post operative bimalleolar surgery.
Methods
A total of 61 patients treated with bimalleolar surgery were enrolled. The patients were divided into three groups: the
first group (n=22) treated only with the surgery, the second group (n=18) treated by ion resonance and bromelain-vitamin C, and the third group (n=21) was treated with bromelain-vitamin C. All patients in the second and third group underwent adjuvant therapy for 50 days. The criteria to evaluate the three groups during the clinical and radiological follow-up were as follows: complications and soft tissue status. Bone healing measured by the Radiographic Union Score Ankle (RUSA), and functional results were evaluated according to the American Foot & Ankle Score (AFAS).
Results
In the first group nine (out of 22; 40.90%) patients developed complications, in the second group three (out of 18; 16.67%)
and in the third group seven (out of 21; 33.33%) presented complications. There is no statistical difference between the three groups regarding the type of fractures, mean age, gender ratio. The worst radiographic and stiffness results in the first group were found (p=0.006). The second group showed better bone healing (p=0.049), better performance in functional recovery measured by AFAS (p=0.039).
Conclusion
Ion resonance and bromelain-vitamin C group showed better outcomes to improve the functional outcome; it allows reduction of complications, consequently, an early return to quality life, and a corresponding improvement of the quality of life.
Histopathological spectrum of lumbar disc changes in obesity: analysis of intervertebral discs in lumbar hernia patients in Zenica-Doboj Canton, Bosnia and Herzegovina
Authors: Juković-Bihorac Fatima , Bečulić Hakija , Begagić Emir , Pugonja Ragib , Radovanović Jovana , Džidić-Krivić Amina , Bašić Binasa , Popov Andrej , Sefo Haso , Iljazović Ermina
Published: April 2024

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.
Tibiotalocalcaneal arthrodesis in a rare case of tuberculosis of the talus
Authors: Comis Chiara , Greco Tommaso , Inverso Michele , Mascio Antonio , Polichetti Chiara , Barbaliscia Marco , La vergata Vincenzo , Mosca Massimiliano , Caravelli Silvio , Mondanelli Nicola , Troiano Elisa , Maccauro Giulio , Perisano Carlo
Published: April 2024

Aim
To assess our personal experience of a case of tuberculosis of the talus, and to provide an overview of the literature about this tuberculosis manifestations, including all its aspects: epidemiology, clinical and imaging presentation, and all the treatments available to the current state of knowledge.
Methods
We present our experience in a case of a 34-year-old patient, who came to our attention with difficulty in walking and
pain due to a talar tuberculosis, with consequent bone disruption and reabsorption, and foot deformities.
Results
A tibiotalocalcaneal arthrodesis with retrograde nail and bone graft was performed after antibiotic therapy. Today, almost
two years after treatment, the patient can walk independently with no major limitations in everyday life.
Conclusion
Tibiotalocalcaneal arthrodesis with bone graft showed good functional results in this case study, with complete graft fusion and good functional and radiological outcomes.