BackgroundPostoperative atrial fibrillation (POAF) is the most common complication associated with higher mortality rates, prolonged hospitalization, and increased treatment costs.The aimof this cross-sectional longitudinal study is to compare the incidence of POAF after coronary artery bypass grafting (CABG) performed with different surgical techniques. The primary outcome is defined as a heart rhythm disorder with atrial fibrillation characteristics that lasts longer than 5 min or requires treatment due to clinical instability.MethodsThe study included 229 hemodynamically stable patients with isolated coronary artery disease who underwent elective CABG. 153 patients underwent CABG with use of cardiopulmonary bypass (ONCAB) and 76 patients without it (OPCAB). In the preoperative risk assessment with modified score, the risk of POAF was higher in the ONCAB group.ResultsPOAF occurred in 86 (37.55%) of a total 229 patients. The number of new cases of POAF is lower in the OPCAB 36 (15.72%) compared to 50 (21.83%) in the ONCAB group (p = 0.031). In the postoperative period there was a significant difference in the time of onset of the primary outcome, the time spent in the IUC and the length of hospitalization.ConclusionPOAFs are more common in ONCAB operating technique. The OPCAB technique reduces postoperative complications, shortens the stay in the IUC and the length of hospitalization, and reduces treatment costs.

BACKGROUND: Despite improvements, survival rates for gastric cancer remain low, even in developed countries, confirming the role of primary and secondary prevention. OBJECTIVE: This study aims to demonstrate the role of additional suspension sutures on the esophagojejunal anastomosis (EJA) to strengthen the anastomosis, i.e., relieve the mechanical suture. METHODS: A retrospective cohort study was conducted from 2011 to 2022 at the Clinic for Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina. The experimental group consisted of patients placed with a suspension suture at the esophagojejunal anastomosis (EJA) site after total gastrectomy. The control group was patients without a suspension suture. The clinical and laboratory parameters available from the medical history were analyzed, X-ray passage, surgical complications, non-surgical complications, the length of hospitalization, the postoperative course, time of onset of postoperative complications, postoperative radiological follow-up and endoscopic postoperative follow-up were then analyzed. RESULTS: A total of 212 patients were included in the study: 87 in the experimental group with suspension sutures on the EJA and 125 in the control group without suspension sutures on the EJA. The two cohorts did not differ in other clinicopathologic parameters except perineural invasion, which was more prevalent in the control group. Patients in both groups were anemic and elevated values of C reactive protein (CRP) and decreased levels of proteins, albumin and globulin, with no significant difference between the two groups. The most common general complication was pleural effusion (28%), followed by pneumonia ( ∼ 22%). The most common complication in the experimental group was an intraabdominal abscess, while in the control group, it was a surgical wound infection. CONCLUSION: Our study did not show a statistically significant difference between the two analyzed EJA techniques created with a circular stapler, when it comes to postoperative course and outcome in patients with gastric cancer.

Background : Both objective and subjective transvaginal sonography (TVS) methods are used to assess the degree of myometrial invasion (MI). Subjective TVS assessment of MI ( < 50% or > 50%) may be as good or better than any objective measurement technique. The aim of this study is to examine the ultrasound characteristics of endometrial cancer (EC) in two groups of patients; with myometrial invasion less and greater than 50%. Methods : This is a prospective cohort study included 60 female patients with pathohistologically (PHD) proven endometrial cancer. Patients were divided into two groups, after surgery and PHD assessment of MI degree, into those with less and more than 50% MI. The degree of MI was performed by subjective assessment ( < 50% and > 50%). Results : The frequency of anteroposterior (AP) diameter of EC greater than 2 cm was statistically significantly higher in the group of subjects with MI > 50% ( p < 0.00001). The volume of EC in the group of patients with MI > 50% is statistically significantly higher, with a difference of 10.48 milliliters compared to the group of subjects with MI < 50% ( p < 0.00014). The difference in the average distance of the EC from the serosa is 0.11 cm between the two examined groups and is statistically significant ( p = 0.0394). The kappa concordance coefficient for the subjective TVS method versus the PHD finding was statistically significant ( p < 0.001), and was kappa = 0.72. Analysis of the diagnostic accuracy showed that the subjective TVS method compared to the gold standard in the diagnosis of MI > 50% has a good diagnostic value: accuracy = 0.87; sensitivity = 0.77; specificity = 0.94; positive predictive value = 0.91; negative predictive value = 0.84; positive likelihood ratio = 13.08; negative likelihood ratio = 0.25. According to the subjective method of TVS, the degree of MI was overestimated in 5.9% of respondents, underestimated in 23.1%. Conclusions : The three dimensions, as well as the volume of endometrial cancer, obtained by TVS, are significantly higher in subjects with > 50% myometrial invasion; there is also a significantly higher frequency of EC diameter greater than 2 cm in the group of subjects with > 50% myometrial invasion.

Introduction: Providing adequate healthcare for premature infants is an important issue in perinatal medicine. The aim of this study is to assess the level of the perinatal healthcare institution (PHI) where the newborns were delivered and the possibilities of transporting them to the cantons of the Federation of Bosnia and Herzegovina. The authors also aimed to examine the overall survival of low birth-weight infants (LBWI) in the Federation of Bosnia and Herzegovina and to compare the survival of newborns according to the PHI where they were born and the PHI where they were treated. Materials and methods: This cross-sectional study included newborns of both sexes that were born in the maternity wards in 10 cantons of the Federation of Bosnia and Herzegovina with a gestational age between 22 and 42 weeks, and a birth weight less than 2500 g. Result: From the PHI of the first and second level, 159 newborns were referred to the third level. A total of 159/669 (23.7%) were referred from a second level PHI to a third level PHI, and 127/669 (l8.9%) LBWI were definitely taken care of. A total of 513/669 (76.8%) LBWI were definitely taken care of in the third level PHI. Out of a total of 159 LBWI referred from other PHI, only 31 (19.5%) LBWI were transported in less than 4 h, and 128 (80.5%) newborns were admitted to the third level PHI within 4 h of birth (P<0.0001). In second level PHI, most LBWI died in the first 12 h after birth, while in third level PHI, 69.2% of LBWI died after 1 week of life. Conclusion: Based on world experience and assessment of the situation in Federation of Bosnia and Herzegovina, it is necessary to take measures to improve perinatal care and its regional organization.

Background : Acute abdomen (AA) is a synonym for a condition caused by an acute disease of an intra-abdominal organ that requires urgent surgical intervention. The gynecological-obstetrical etiopathogenesis of AA is based on pathological events on the genital organs due to hemorrhagic, inflammatory, and ischemic/obstructive genesis, and is a significant reason for admission to emergency gynecological departments, and emergency surgery. Methods : A retrospective clinical research was performed from 2005 to 2021, from the surgical protocol of the University Department for Gynecology and Obstetrics, Clinical Hospital “Sveti Duh” in Zagreb. In the examined sixteen-year period, 703 patients (4.06%) had surgery with a diagnosis of AA. Results : The largest number of surgeries due to AA was performed in the age group of 21–45 years (74.40%), i.e., in the reproductive age, followed by 106 patients aged 46–52 years (15.07%), then 46 (6.54%) patients in children and adolescent age up to 20 years of age, then from 53–60 years 23 (3.27%) patients, and in the elderly > 60 years old, with 5 (0.71%) patients. The etiopathogenetic factors of AA were: the most common intra-abdominal hemorrhage in 68.14%, followed by inflammation and the most common complications of pelvic inflammatory disease in 25.60%, ischemic-obstructive causes in 2.56% and other causes in 3.7%. Out of the total number of surgeries, 450 (64.01%) were due to ectopic tubal pregnancy. Out of the total number of surgeries, 549 (78.09%) were performed (completed) by laparoscopy procedures, and by laparotomy and/or relaparotomy in 154 cases (21.90%). Regarding laparoscopy, 93.48% was performed in the age group up to 20 years, 83.56% in the age group of 21–45 years, and 62.26% was performed in the age group of 46–52 years. Regarding laparotomy, 69.57% was performed in patients aged 53–60 years, and 100% in the age group of patients > 60 years. A pathological substrate was found for all operated patients, which they undergo for surgery, and we had no cases in which we did not prove a perioperative or pathohistological reason for AA. There were no patients’ deaths in the current study, which had to undergo for surgery for AA. Conclusions : We emphasize the urgent need for proper and continuous education of hospital teams, as well as extra-hospital emergency teams in recognizing AA symptoms of gynecological genesis based on history, clinical palpation examination, and ultrasound examination as a fundamental triad in the diagnosis of this life-threatening condition that requires only surgical treatment.

BACKGROUND: Following the latest trends in the development of artificial intelligence (AI), the possibility of processing an immense amount of data has created a breakthrough in the medical field. Practitioners can now utilize AI tools to advance diagnostic protocols and improve patient care. OBJECTIVE: The aim of this article is to present the importance and modalities of AI in maternal-fetal medicine and obstetrics and its usefulness in daily clinical work and decision-making process. METHODS: A comprehensive literature review was performed by searching PubMed for articles published from inception up until August 2023, including the search terms “artificial intelligence in obstetrics”, “maternal-fetal medicine”, and “machine learning” combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. RESULTS: According to recent research, AI has demonstrated remarkable potential in improving the accuracy and timeliness of diagnoses in maternal-fetal medicine and obstetrics, e.g., advancing perinatal ultrasound technique, monitoring fetal heart rate during labor, or predicting mode of delivery. The combination of AI and obstetric ultrasound can help optimize fetal ultrasound assessment by reducing examination time and improving diagnostic accuracy while reducing physician workload. CONCLUSION: The integration of AI in maternal-fetal medicine and obstetrics has the potential to significantly improve patient outcomes, enhance healthcare efficiency, and individualized care plans. As technology evolves, AI algorithms are likely to become even more sophisticated. However, the successful implementation of AI in maternal-fetal medicine and obstetrics needs to address challenges related to interpretability and reliability.