Background/Objectives: Postoperative bleeding remains a major complication following coronary artery bypass grafting (CABG), contributing to transfusion requirements, reintervention, and morbidity. The objective of this study was to assess the clinical significance of preoperative platelet function testing and postoperative viscoelastic testing in patients undergoing elective isolated on-pump CABG. Methods: This prospective observational study included 708 patients undergoing surgery between January 2023 and January 2025. Preoperative platelet function was assessed with Multiplate® impedance aggregometry (ADPHS and ASPI), and postoperative coagulation was assessed with ClotPro® after cardiopulmonary bypass. The prespecified Multiplate thresholds were population- and assay-specific and were not intended as universal cutoffs. Postoperative bleeding was defined by cumulative chest-tube drainage during the first 24 h. Results: In unadjusted analyses, low ADPHS values (≤602.5 AU·min) were associated with higher platelet transfusion, cryoprecipitate use, and overall transfusion, and ADPHS showed modest discrimination for blood loss > 500 mL/24 h (AUC = 0.61, p = 0.041). Low ASPI values (≤453 AU·min) were associated with increased cryoprecipitate use and showed modest discrimination for blood loss > 1000 mL/24 h (AUC = 0.62, p = 0.005). After multivariable adjustment for baseline differences, neither ADPHS ≤ 602.5 (adjusted OR 1.01, 95% CI 0.74–1.39, p = 0.936) nor ASPI ≤ 453 (adjusted OR 0.89, 95% CI 0.64–1.23, p = 0.475) was independently associated with postoperative bleeding > 500 mL/24 h. Postoperative ClotPro® parameters showed statistically significant associations with transfusion and bleeding, but their discriminatory performance was limited. Conclusions: Perioperative platelet function and viscoelastic test results were associated with bleeding and transfusion outcomes in unadjusted analyses, but discrimination was modest, and the platelet function cutoffs were not independently associated with bleeding > 500 mL after adjustment. These findings support a complementary hemostatic assessment role for combined POC testing but do not establish a standalone predictive model or an implementable transfusion algorithm.

Background: The clinical course of COVID-19 is highly variable, ranging from asymptomatic infection to critical illness with hyperinflammation and multiorgan failure. Oxidative stress plays a central role in COVID-19 pathogenesis, and genetic polymorphisms in glutathione S-transferase (GST) enzymes, particularly GSTM1 and GSTT1 null genotypes, may impair antioxidant defense and exacerbate inflammatory responses. This study aimed to investigate the association of GSTM1 and GSTT1 null genotypes with both disease severity and serum cytokine levels in hospitalized COVID-19 patients. Methods: This cross-sectional study enrolled 137 COVID-19 patients hospitalized during the second pandemic wave (July–September 2020). Patients were stratified into mild (n = 67) and severe (n = 70) groups based on clinical criteria. GSTM1 and GSTT1 polymorphisms were determined by multiplex polymerase chain reaction. Serum levels of 13 cytokines were measured using flow cytometry. Logistic regression analyzed genotype associations with disease severity, and multivariate linear regression assessed relationships between null genotypes and pro-inflammatory cytokine levels (IL-6, TNF-α, IL-17A, IFN-γ), adjusted for age, sex, hypertension, and diabetes. Results: The GSTT1 null genotype was significantly associated with severe COVID-19 (adjusted OR = 2.56, 95% CI: 1.08–6.07, p = 0.032). Severe patients exhibited significantly elevated levels of IL-6 (75.6% increase, p = 0.008), TNF-α (69.4% increase, p = 0.005), IL-17A (54.4% increase, p = 0.016), and IFN-γ (10.1% increase, p = 0.021). Both GSTM1 and GSTT1 null genotypes were associated with higher levels of these cytokines, with stronger effects observed for GSTT1 null. In multivariate analysis, GSTT1 null independently predicted elevated IL-6 (β = 52.6, p = 0.003), TNF-α (β = 13.8, p = 0.002), IL-17A (β = 2.4, p = 0.001), and IFN-γ (β = 56.4, p = 0.012). The combined both null genotype showed the strongest associations but was limited by small sample size (n = 10) and should be interpreted with caution. Conclusions: The GSTT1 null genotype is associated with severe COVID-19 and appears to be associated with heightened pro-inflammatory cytokine responses, particularly IL-6, TNF-α, IL-17A, and IFN-γ. These findings suggest a potential role for genetic impairment of antioxidant defense may contribute to hyperinflammation in COVID-19 hyperinflammation, although validation in larger cohorts is needed.

Morton’s neuroma refers to a degenerative, compressive neuropathy affecting one of the common digital nerves in the forefoot, typically situated between the heads of the third and fourth metatarsal bones. The condition arises primarily due to repetitive compression and mechanical irritation of the interdigital nerve, particularly beneath the plantar portion of the transverse intermetatarsal ligament. Although historically labelled a “neuroma,” this entity lacks neoplastic features and is instead characterised by perineural fibrosis and nerve degeneration. It is known by several alternative terms in medical literature, including interdigital neuritis, intermetatarsal neuroma, Morton’s metatarsalgia, interdigital neuralgia, interdigital nerve entrapment, and interdigital compression neuropathy (1, 2). This case report describes a 45-year-old female patient with a typical Morton’s neuroma, who underwent surgical treatment after experiencing symptoms for over a 15 years.

Background/Objectives: Sarcopenia (SP) and osteoporosis (OP) are common yet underrecognized complications of liver cirrhosis, contributing to increased morbidity and mortality. Their coexistence, termed osteosarcopenia (OS), represents a compounded musculoskeletal impairment. Insulin-like growth factor 1 (IGF-1), synthesized in the liver, has been implicated in muscle and bone metabolism. This study aimed to assess the prevalence and association of laboratory and clinical parameters with SP, OP, and OS in cirrhotic patients, with a focus on IGF-1 deficiency and their impact on mortality. Methods: This cross-sectional study included 100 cirrhotic patients at a tertiary center. Sarcopenia was diagnosed using CT-derived L3 skeletal muscle index and osteoporosis via the DEXA scan. IGF-1 levels and metabolic parameters were measured. Multivariate logistic regression identified laboratory and clinical factors associated with musculoskeletal complications. However, due to the cross-sectional design, causal relationships could not be inferred. Results: SP, OP, and OS were present in 41%, 22%, and 11% of patients, respectively. IGF-1 levels were significantly lower in patients with SP, OP, and OS (p < 0.05) and were independently associated with increased risk of SP (OR = 1.797, p = 0.006), OP (OR = 1.873, p = 0.045), and OS (OR = 2.326, p = 0.003). Mortality rates were significantly higher among patients with OS (72.7%), OP (77.3%), and SP (56.1%). OS conferred the highest adjusted mortality risk (OR = 2.739, p = 0.009), followed by SP (OR = 2.278, p = 0.015) and OP (OR = 1.958, p = 0.036). Conclusions: Musculoskeletal complications are highly prevalent and predictive of mortality in cirrhosis. IGF-1 deficiency is a strong independent biomarker for SP, OP, and OS. Routine screening and early intervention targeting IGF-1 pathways and nutrition may improve outcomes in this population.

<p><strong>Introduction.</strong> The most common malignant facial skin tumors are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Surgical excision remains the gold standard of treatment, followed by reconstruction of the resulting defect. The aims of this study were to present reconstructive options for facial defects following excision of malignant skin tumors and to evaluate functional and aesthetic outcomes of local flap reconstruction.<br /><strong>Methods</strong>. This retrospective case series included 80 patients surgically treated at Varis Clinic in Belgrade and at the Department of Plastic and Reconstructive Surgery, University Hospital in Foča, from January 2021 to October 2025. Patients were analyzed with respect to tumor type, defect size and localization, sex, age, and postoperative complications. Reconstruction was performed using local flaps.<br /><strong>Results.</strong> Facial defects resulted from excision of BCC in 51 patients, SCC in 24 patients, and melanoma in five patients. Complete flap survival was achieved in all cases (100%). Postoperative infection with marginal flap necrosis occurred in three patients (3.75%) and resolved after conservative treatment. Functional and aesthetic outcomes were satisfactory in all patients.<br /><strong>Conclusion.</strong> Local flaps represent a reliable reconstructive method for small to large facial defects. Proper surgical planning, anatomical knowledge, and meticulous technique are essential for achieving optimal functional and aesthetic outcomes.</p>

Introduction: Ewing’s sarcoma is a rare malignant tumour predominantly affecting children and adolescents, typically originating in bone or soft tissue. Primary intracranial involvement is extremely rare, especially in adults. Most reported intracranial cases are dural-based and extra-axial, while intra-axial or mixed presentations are exceptionally rare.Case report: We report a unique case of a 49-year-old male who presented with a generalised seizure and postictal dysphasia. Imaging revealed a large cystic (intra-axial) tumour with a mural solid component (extra-axial part) in the left temporoparietal region. Gross total resection was performed without complications. Histopathological and molecular analyses confirmed the diagnosis of primary intracranial Ewing’s sarcoma. Despite recommendations, the patient refused further oncological treatment and was lost to follow-up after three months, during which no recurrence was detected on imaging.Conclusion: This case illustrates a rare adult presentation of primary intracranial Ewing’s sarcoma with mixed intra- and extra-axial features, highlighting the importance of considering rare entities in the differential diagnosis of atypical brain lesions. It also raises the possibility of post-surgical chronic inflammation as a potential factor in tumour pathogenesis, warranting further investigation.

<p>Inguinal hernia represents a significant global health challenge, with more than 20 million operations performed annually. This paper provides a comprehensive review of contemporary practice, critically analyzing the evolution of treatment from the concept of the &ldquo;gold standard&rdquo; toward a personalized approach. The study integrates the latest epidemiological data, analyzes risk factors, and offers a comparative assessment of surgical techniques, focusing on the Lichten<br />stein technique and minimally invasive approaches. Special attention is devoted to redefining chronic postoperative pain, discussing controversies such as the use of synthetic meshes in contaminated fields, and examining the long-term outcomes of the &ldquo;watchful waiting&rdquo; strategy. The findings indicate that the success of intervention depends on surgeon experience, hernia and patient characteristics, as well as resource availability, which is particularly illustrated by the analysis of practice in Bosnia and Herzegovina. It concludes that achieving optimal outcomes requires long-term patient follow-up, standardization of protocols, and holistic economic analysis, together with the implementation of innovative technologies such as artificial intelligence in preoperative planning.</p>

Intracranial dermoid cysts are rare, congenital, non-neoplastic lesions accounting for less than 1% of all intracranial masses. They may become symptomatic upon rupture, typically due to the accumulation of sebaceous material and hair within the cyst, which can lead to aseptic chemical meningitis. We present the case of a 38-year-old male, who experienced an epileptic seizure. Imaging studies revealed a large lesion in the right temporo-frontal region, with findings most consistent with a ruptured dermoid cyst. The patient underwent near-total surgical resection, and histopathological analysis confirmed the diagnosis. Postoperative recovery was uneventful, and regular follow-up was advised. This case underscores the importance of including ruptured dermoid cysts in the differential diagnosis of cystic brain lesions, particularly in patients presenting with seizures or other neurological symptoms.

Background: Undernutrition disorder is a prevalent comorbidity (up to 25%) in type 2 diabetes (T2D) patients which significantly compromises their health. We aimed to assess the association between single nucleotide polymorphysms (SNPs) adiponectin (ADIPOQ) +276 (G/T) and resistin (RETN) −420 (C/G) with the risk of developing T2D and undernutrition in patients with T2D. Methods: The research was conducted as prospective case-control study among 106 patients with T2D and 106 healthy control individuals in the territory of the Bosnia and Herzegovina from Sep 1st 2022 to May 1st 2023. For assessing the nutritional status, the mini nutritional assessment (MNA) was used. DNA analysis was carried out by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) method. The data were analyzed using chi-square test, t-test for independent samples and binary multivariate logistic regression. Results: The research included 212 subjects of which 124 (58.5%) were male. The mean age of the subjects was 68.48±4,67 yr. Almost 20% of subjects were undernourished, significantly more T2D patients when compared to controls (33% vs. 6.6%; P<0.001). ADIPOQ +276 GT genotype was identified as significant predictor of T2D (OR: 3.454; 95% CI: 1.400–8.521; P=0.007) and undernutrition disorder (OR: 3.453; 95% CI: 1.331–8.961; P=0.011) in T2D population, while the presence of RETN −420 CG genotype had protective effect against occurrence of T2D (OR: 0.353; 95% CI: 0.144–0.867; P=0.023). However, RETN genotypes were not associated with undernutrition disorder. Conclusion: ADIPOQ +276 gene polymorphism represent a significant predictor for development of T2D and undernutrition disorder in T2D population, while RETN −420 gene polymorphism was identified as a significant factor associated with a reduced risk for T2D, but was not associated with undernutrition.