Background DIALOG + is a low-cost intervention proven to improve the subjective quality of life in patients with psychosis and anxiety disorders in low- and middle-income countries. In a recent study, DIALOG + was shown to be feasible for patients in primary care settings with long-term physical conditions and to result in an improvement in patient outcomes. The aim of this qualitative study was to explore the experiences of patients and clinicians using DIALOG + in Bosnia and Herzegovina to gain a better understanding of its impact in this setting. Methods In-depth semi-structured interviews were conducted with 11 patients and 4 physicians, as well as two focus groups with 5 patients in each, all of whom participated in the intervention. Specific life and treatment domains discussed during the sessions between patients and clinicians were also analysed to determine which domains were most frequently addressed and where patients needed the most support. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Results Four qualitative themes were identified: (1) DIALOG + structure and solution-oriented approach are helpful; (2) DIALOG + allows space for conversation; (3) Therapeutic relationship is improved, and (4) The intervention has its limitations. Conclusions DIALOG + is a novel primary care intervention with positive effects on patients’ lives, which enhance primary care. Nevertheless, it presents a new challenge in this setting. It is necessary to make adjustments in primary care, such as providing clinicians with more extensive training and ongoing support, as well as providing more time for the intervention’s implementation. Trial registration Study was registered prospectively within the ISRCTN Registry: ISRCTN17003451, 02/12/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-025-02845-7.

INTRODUCTION Acute bacterial meningitis (ABM) is a serious infectious disease and medical emergency. Given the fact of its high mortality and morbidity, detecting prognostic factors is potentially useful in improving treatment strategies. This paper aims to determine prognostic factors of short-term outcomes of patients with ABM in a developing country - Bosnia and Herzegovina, measured by the Modified Rankin Scale (MRS) at discharge. METHODOLOGY In this retrospective cohort study, 56 patients treated at the Clinic of Infectious Diseases, Clinical Center University of Sarajevo, for 11 years (2012-2022) were included. Statistical analysis was performed using IBM SPSS Statistics version 29.0.1.0. RESULTS The subjects' average age was 31.6 ± 27.7 years, with the youngest patient being 4 months and the oldest 75 years old. Among those, 31 were male and 25 were female. Unfavorable outcomes had 16 (28.6%) patients, including fatal outcomes in four patients and severe disabilities in 12 patients (MRS: 2-6), while 40 (71.4%) patients had favorable outcomes (MRS: 0-1). In the multivariate analysis, predictors of unfavorable outcomes included age older than 60 years, duration of symptoms longer than 24 hours, presence of neurological defects at admission, impaired consciousness, respiratory distress, and no corticosteroid use during treatment. CONCLUSIONS There is certainly a window of opportunity for patients with ABM: The shorter the time between disease onset and treatment initiation, the better the disease outcome.

Background/Objectives: Squamous cell lung cancer (SCC) presents a significant treatment challenge due to its poor prognosis and limited therapeutic options. In many resource-limited countries, access to advanced molecular testing is often unavailable, making the identification of novel and reliable prognostic markers crucial for improving patient selection for systemic treatments. Methods: This single-center, retrospective study investigated the prognostic value of inflammatory biomarkers, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in 134 patients diagnosed with SCC. Patients were stratified into groups based on optimal cut-off values determined by ROC analysis for each biomarker. Results: Elevated levels of the SII, NLR, and PLR were significantly associated with shorter overall survival in patients with SCC (all p < 0.05). Conclusions: These easily accessible and cost-effective laboratory parameters are particularly valuable in settings where molecular testing is not available, aiding in the identification of high-risk patients and optimizing treatment selection for chemotherapy.

AIM The position of science and scientific research in Bosnia and Herzegovina (B&H) is unfavourable. University education lacks research programs, hindering students from developing critical evaluation skills. METHODS This cross-sectional study examined knowledge, attitudes, experience and perceived barriers towards scientific research among biomedical students and recent graduates at the University of Sarajevo in B&H. A self-reporting questionnaire was distributed via social networks and among students from all years of the Medical, Dentistry, Pharmaceutical faculties, the Faculty of Health Sciences, and the Faculty of Science, as well as recent graduates. RESULTS The survey was completed by 243 participants. The mean knowledge score of 4.3/11 was noticed; 216 (96%) believed research was necessary for healthcare improvement. Although 147 participants (65.3%) attended courses on research methodology, only 63 (28%) engaged in scientific research at their faculties. Only 5 (8.5%) employed graduates participated in research at their jobs. Almost half, 99 (44%) participants consulted scientific papers only upon recommendation. The majority of participants, 199 (82.2%), reported they experienced barriers to conducting research in B&H. CONCLUSION Biomedical students and graduates demonstrated limited research knowledge, but had positive attitudes and acknowledged significant barriers. Improved faculty curricula in research areas and more opportunities are needed.

Introduction The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. Methods An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. Results A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. Conclusion The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. Trial registration All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).

Background: Chest pain represents a prevalent complaint in emergency departments (EDs), where the precise differentiation between acute coronary syndrome and alternative conditions assumes paramount significance. This pilot study aimed to assess the HEART score’s implementation in West Balkan EDs. Methods: A retrospective analysis was performed on a prospective cohort comprising patients presenting with chest pain admitted to EDs in Sarajevo, Zenica, and Belgrade between July and December 2022. Results: A total of 303 patients were included, with 128 classified as low-risk based on the HEART score and 175 classified as moderate-to-high-risk. The low-risk patients exhibited younger age and a lower prevalence of cardiovascular risk factors. Laboratory and anamnestic findings revealed higher levels of C-reactive protein, ALT, and creatinine, higher rates of moderately to highly suspicious chest pain history, a greater number of cardiovascular risk factors, and elevated troponin levels in moderate-to-high-risk patients. Comparatively, among patients with a low HEART score, 2.3% experienced MACE, whereas those with a moderate-to high-risk HEART score had a MACE rate of 10.2%. A moderate-to-high-risk HEART score demonstrated a sensitivity of 91.2% (95%CI 90.2–93.4%) and specificity of 46.5% (95%CI 39.9–48.3%) for predicting MACE. Conclusion: This pilot study offers preliminary insights into the integration of the HEART score within the emergency departments of the West Balkan region.

Abstract Gut microbiota is known as unique collection of microorganisms (including bacteria, archaea, eukaryotes and viruses) that exist in a complex environment of the gut. Recently, this has become one of the most popular areas of research in medicine because this plays not only an important role in disease development, but gut microbiota also influences drug pharmacokinetics. These alterations in drug pharmacokinetic pathways and drug concentration in plasma and blood often lead to an increase in the incidence of toxicological events in patients. This review aims to present current knowledge of the most commonly used drugs in clinical practice and their dynamic interplay with the host’s gut microbiota as well as the mechanisms underlying these metabolic processes and the consequent effect on their therapeutic efficacy and safety. These new findings set a foundation for the development of personalized treatments specific to each metabolism, maximizing drugs’ therapeutic effects and minimizing the side effects because they are one of the major limiting factors in treating patients.