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Anterior clinoidal meningioma (ACM) remains a challenging lesion to treat surgically due to its intricate neurovascular relationships with surrounding anatomy and often presents with ipsilateral visual loss. Anterior clinoidectomy (AC) by skilled skull base surgeons enables early optic nerve (ON) decompression, tumor devascularization, and radical tumor resection. The authors provide an update on ACM surgery, current views on the role of AC and its impact on outcomes in surgical treatment, as well as a new 2 stage 4 by 4 step concept of ON decompression involving AC. A systematic review of PubMed and meta-regression of surgically treated ACMs was performed. In total, 908 patients were analyzed; 415 (45.7%) underwent routine AC (performed in all cases) and 493 (54.3%) underwent selective AC (planned preoperatively). The routine AC cohort showed higher risk for new cranial-nerve (CN) deficits (12.5% vs. 3.0%; p < 0.001), vascular complications (6.7% vs. 3.3%; p = 0.02), and new focal neurological deficits (5.5% vs. 2.3%; p = 0.04). No differences were found in visual outcomes, gross-total resection, mortality, recurrence, or other major complications. Random-effects meta-regression of routine AC showed increased odds of new CN deficit (odds ratio [OR], 3.34; 95% confidence interval [95% CI], 1.51–7.38; p = 0.005; heterogeneity [I2] = 60.5%) and vascular complication (OR, 2.59; 95% CI, 1.05–6.38; p = 0.04; I2 = 47.8%), with moderate and substantial heterogeneity among routine AC studies, respectively. In experienced hands, AC remains an invaluable tool for ACM treatment as it offers more consistent tumor devascularization, prevention of tumor recurrence, optic nerve decompression, and increased working space, which facilitates optimal tumor resection and better long‐term control and functional outcome. We propose a new didactical structured concept of routine AC via 2-stage, 4 by 4 steps to improve the utility of AC and decrease associated operative risks compared to selective AC.

Introduction: Polycystic ovary syndrome (PCOS) represents a state of androgen-driven metabolic dysregulation where visceral adiposity and inflammation critically define cardiometabolic risk. Visceral adiposity is not a bystander in PCOS; it is an active endocrine organ driving insulin resistance, low-grade inflammation, and androgen persistence. Interventions that reverse adipocyte hypertrophy and inflammatory signaling may therefore alter the metabolic trajectory of PCOS. Beyond its chronobiotic role, melatonin exerts profound metabolic actions via MT1/MT2 receptors in adipose tissue, modulating oxidative stress and inflammatory gene expression. Yet its direct impact on androgen-induced visceral adiposity remains unclear. Aim: The present study aimed to evaluate the effects of melatonin, metformin, and their combination on visceral fat accumulation in a testosterone-induced PCOS rat model. Material and methods: Thirty prepubertal female Wistar rats were randomized into five groups (n=6): control, PCOS (testosterone 20 mg/kg/day), PCOS+metformin (500 mg/kg/day), PCOS+melatonin (2 mg/kg/day), and PCOS+melatonin+metformin. Treatments lasted 36 days. Estrous cyclicity was monitored by daily vaginal cytology, and somatometric parameters were recorded weekly. On day 36, serum, ovaries, and visceral fat were collected for biochemical and histological analysis. Results: Vaginal smear changes and ovarian pathological alteration due to prolonged testosterone exposure confirmed the successful induction of the PCOS model. Measures of central adiposity, including abdominal circumference and the TC/AC ratio, were significantly higher in the PCOS model than in controls (p < 0.001). Abdominal circumference (AC) increase was greatest in the PCOS model (p < 0.001), while all treatment groups showed significant reductions, most notably in the melatonin + metformin group, followed by melatonin monotherapy and then metformin (all p < 0.001 vs. PCOS). Melatonin was more effective than metformin (p=0.029). AC/TC reduction was greatest in the combined treatment group (p < 0.05). Total weight gain among groups did not reach statistical significance. While total visceral fat weight did not differ among groups, histology revealed a marked reduction in adipocyte number in treated animals, most pronounced in the melatonin group (p < 0.033). Conclusion: Our findings identify melatonin as a metabolic modulator of androgen-driven adiposity, supporting its potential as an adjunctive therapy targeting visceral fat and inflammation in PCOS

Abstract Due to an ongoing energy crisis and fluctuating energy prices, the prerequisites for maintaining optimal indoor environmental quality (IEQ), a critical determinant of productivity, cognitive performance, and overall well-being, have been significantly disrupted. This study focuses on examining determinants of thermal comfort, a subjective evaluation of the thermal environment and a key component of IEQ. Through a survey of employees and users of public buildings in Bosnia and Herzegovina, the research employs a four-stage regression analysis to identify the main predictors of thermal comfort. Although 71.33% of respondents report satisfaction with the heating system, only 43.13% find the heating to be adequate, with the optimal perceived temperature averaging 21.66°C. The results show that key factors influencing thermal comfort include thermal sensation, thermal memory, gender, and respondent type (employee versus user). These seminal results could offer valuable productivity and financial implications for energy savings, especially for budgetary policymakers aiming to reduce energy consumption as well as for public sector management and public institutions seeking to improve well-being and productivity.

Treatment of Clostridioides difficile infections in University Clinical Hospital Mostar from an economic perspective Clostridioides difficile is the most prominent pathogen directly tied to a healthcare system and proven to be one of the main causes of high economic impacts. It results in a frequent need for hospitalization, including the treatment of sepsis and post-acute care, and requires an extended number of days spent at the hospital. In addition to the costs of the medicine and laboratory analysis, extended hospitalization is the key component of the high healthcare expenses. The rational use of antibiotics, mandatory implementation of general hygiene measures, like washing hands, and disinfecting surfaces can significantly contribute towards hospital's overall expenses. This is particularly important for those in contact with an infected patient or with a patient suspected of having CDI. These basic measures establish security systems in the prevention of CDI. Proper managing and forecasting of the costs on the annual level for each individual healthcare institution is a necessary measure. Developing an accurate estimate of the funds needed for the treatment and prevention of CDI and its best Treatment of Clostridioides difficile infections in University Clinical Hospital Mostar from an economic perspective Clostridioides difficile is the most prominent pathogen directly tied to a healthcare system and proven to be one of the main causes of high economic impacts. It results in a frequent need for hospitalization, including the treatment of sepsis and post-acute care, and requires an extended number of days spent at the hospital. In addition to the costs of the medicine and laboratory analysis, extended hospitalization is the key component of the high healthcare expenses. The rational use of antibiotics, mandatory implementation of general hygiene measures, like washing hands, and disinfecting surfaces can significantly contribute towards hospital's overall expenses. This is particularly important for those in contact with an infected patient or with a patient suspected of having CDI. These basic measures establish security systems in the prevention of CDI. Proper managing and forecasting of the costs on the annual level for each individual healthcare institution is a necessary measure. Developing an accurate estimate of the funds needed for the treatment and prevention of CDI and its best

Abstract Introduction This study examines the prevalence of bullying among primary school students in the Federation of Bosnia and Herzegovina (FBiH), analyses gender differences, and assesses its association with traumatic and psychosomatic symptoms. Methods This cross-sectional study was conducted among students in grades seven to nine. Participants were categorised based on bullying involvement as victims, bullies, bully/victims, or uninvolved. Validated self-report questionnaires were used to measure bullying exposure and assess psychosomatic and trauma-related symptoms. Results In total, 13.3% of the students identified as victims, 3.1% as bullies, and 4.4% as both. Victims and bully/victims reported significantly higher rates of psychosomatic symptoms (e.g., pain, fatigue, gastrointestinal complaints) and trauma-related symptoms (e.g., anxiety, depression, dissociation) than uninvolved students. Bully/victims showed the highest overall burden, suggesting compounded vulnerability. Conclusions These findings highlight the urgent need for trauma-informed, context-sensitive prevention strategies. Training school staff to recognise emotional and somatic distress, integrating basic screening tools into school and primary health services, and enhancing intersectoral collaboration are critical steps in ensuring early identification and adequate support for affected students.

Recent excavations at Pompeii’s Regio IX have uncovered an intact ancient construction site, offering insights into Roman building techniques at the time of the eruption of Mount Vesuvius in 79 CE. Microstructural and chemical analysis of materials collected from previously constructed walls, walls under construction, and adjacent dry, raw material piles show unequivocally how quicklime was pre-mixed with dry pozzolan before adding water in the creation of Roman concrete. This construction method, also known as hot mixing, results in an exothermic reaction within the mortar and the formation of lime clasts, key contributors to the self-healing and post-pozzolanic reactivity of hydraulic mortars. The analysis of reaction rims around volcanic aggregates demonstrate aggregate/matrix interfacial remodeling, where calcium ions originating from the dissolution of lime clasts diffuse and remineralize, producing amorphous phases and various polymorphs of calcium carbonate (including calcite and aragonite). Furthermore, the parallel discovery of masonry materials and tools permits elucidation of the entire construction workflow, including the steps required to process binding mortars and larger aggregates (caementa). These findings advance our understanding of ancient Roman construction and long-term material evolution, providing a scientific basis for developing more durable and sustainable concretes and restoration materials inspired by ancient practices. Here the authors combine microstructural and chemical analysis of building materials collected from an active construction site in Pompeii prior to the eruption of Mount Vesuvius in 79 CE. Through these analyses, they identify the key raw materials and processes used in the production of Roman concrete.

Urinary tract infections, as one of the most common infectious diseases, contribute substantially to the global healthcare burden, particularly due to the rising prevalence of resistant bacterial strains such as Klebsiella pneumoniae. Background/Objectives: The aim was to investigate the prevalence of urinary tract infection pathogens among hospitalized patients at Saint Apostol Luka Hospital in Doboj during the period 2021–2023. Methods: This retrospective cross-sectional study was conducted at Saint Apostol Luka Hospital, Doboj, Republic of Srpska, Bosnia and Herzegovina. Data from the Department of Microbiology were analyzed for the period 2021–2023, including patients with positive urine cultures (≥103 CFU/mL) of a single uropathogen. Bacterial identification and susceptibility testing were performed according to EUCAST standards, and statistical analysis was carried out using SPSS v24. Results: Escherichia coli was the most frequent isolate (29.2%), followed by Klebsiella spp. (24.2%) and Enterococcus spp. (19.8%). A significant rise in K. pneumoniae prevalence and resistance to multiple antibiotics—including β-lactams, carbapenems, aminoglycosides, and colistin—was observed during the study period. Conclusions: This study revealed that E. coli and Klebsiella spp. were the leading uropathogens, with notable differences in distribution by sex, age, and hospital department. A marked rise in multidrug resistance, particularly among K. pneumoniae, was observed across the study period. These findings underscore the urgent need for continuous surveillance and stronger antimicrobial stewardship to curb resistance trends.

Spent coffee grounds (SCG) offer significant ecological and cosmetic potential. The conversion of SCG into safe and efficient cosmetic products promotes all aspects of sustainability and circular practices within the cosmetic industry.

The aim of this study is to investigate how the link between a country’s legislative and executive branches affects its ability to maintain fiscal discipline through mediating effects of economic reforms. The research bases its analysis on an investigation of NMS-11 countries between 1991 and 2022 using Quantile Mediation Analysis (QMA). It begins with an estimation of the impact of political institutions on fiscal sustainability and then continues with an investigation of the ways how political institutions influence the implementation of economic reforms through a mediator model. Moreover, in an attempt to evaluate the mediation effect, the study uses relevant coefficients taken from prior analyses to compute the indirect impact across quantile distributions. The study sheds the importance of the context in evaluating the role of political institutions and economic reforms on fiscal sustainability, highlighting the varying effects at different quantile levels. In fact, economic reforms are shown to be important when fiscal stress is at a relatively low level and are relatively less effective when the stress is high because the impact of the reforms and institutional factors differs according to the distribution of debt to GDP. This investigation shows that political stability and fiscal outcomes are interactive by segmenting this group into legislative, executive, judicial, and federal dimensions. Politicians should focus on improving the democratization processes of the lower house to facilitate accountability and decision-making when it comes to the judiciary to assist in fiscally integrating during some rough patches. They should also use specific economic actions regarding debt as well as apply the federal policies relevant to various forms of federalism to provide successful reforms.

Aims: To evaluate the impact of the COVID-19 pandemic on breast cancer presentation, surgical management, and lymph node involvement in a small, understudied population in Brčko District, Bosnia and Herzegovina. Methods: A retrospective cohort study conducted at the General Hospital of Brčko District, Bosnia and Herzegovina, from March 2018 to March 2022. We included 113 patients with histopathologically confirmed breast cancer. We divided the patients into two groups: the before-COVID group (65 patients, including one male) treated from March 2018 to March 2020, and the during-COVID group (47 patients) treated from March 2020 to March 2022. We analyzed patient data (age, gender, menopausal status) along with tumor and lymph node histopathological characteristics. Results: The number of surgeries performed decreased by 16.9% during the COVID period. Patients in the pre-COVID group mostly had grade II tumors, while those in the post-COVID group had predominantly grade III tumors. The average number of lymph nodes sampled was similar between groups (10.70 ± 4.12 before COVID vs. 10.39 ± 4.66 during COVID). Still, the average number of positive lymph nodes was higher in the COVID group (2.5±3.82) compared to the pre-COVID group (1.64±2.90). For patients without neoadjuvant therapy, the average time to surgery increased from 1.04 months (±0.66) before the COVID-19 pandemic to 2.59 months (±2.88) during the COVID-19 pandemic. For those receiving neoadjuvant therapy, time to surgery increased from 5.45 months (±2.97) to 7.29 months (±5.15). Conclusion: The COVID-19 pandemic led to delayed breast cancer management, higher tumor grade, and increased lymph node involvement in a small, resource-limited healthcare setting. Findings highlight the need for resilient oncology services in smaller districts during public health crises.

Background: Antimicrobial resistance (AMR) is now a critical issue in South Africa, enhanced by considerable inappropriate prescribing of antibiotics. There is currently variable dispensing of antibiotics without a prescription. Where this occurs, it is principally for urinary tract infections (UTIs) and sexually transmitted infections (STIs). Consequently, there is a need to comprehensively evaluate antibiotic dispensing patterns and factors influencing this to reduce AMR. Methods: A previously piloted questionnaire was administered to patients exiting three different categories of community pharmacies in a rural province. The questionnaire included data on the prevalence of antibiotics dispensed, whether without a prescription, and the rationale for this. Results: A total of 465 patients leaving community pharmacies with a medicine were interviewed. 54.4% of interviewed patients were dispensed at least one antibiotic, with 78.7% dispensed these without a prescription from either independent or franchise pharmacies. Metronidazole (36.1%) and azithromycin (32.7%) were the most dispensed antibiotics. STIs were the most common infectious disease for which an antibiotic was dispensed (60.1%), with 99.6% dispensed without a prescription. Upper respiratory tract infections (URTIs) were the most common infection where antibiotics were dispensed with a prescription (60.0%), with little dispensing without a prescription (7.1%). The most frequently cited reasons for obtaining antibiotics without a prescription were prior use (56.8%), long waiting times at PHC clinics (15.6%), and financial constraints (6.0%). Conclusions: There is an urgent need to review community pharmacists’ scope of practice, including allowing them to prescribe antibiotics for infectious diseases such as UTIs, similar to other countries. Concomitantly, utilise trained community pharmacists to engage with prescribers to improve future antibiotic use, especially for URTIs.

Abstract This study examines the incorporation of soft skills, digital competencies, and artificial intelligence (AI) tools in higher education to improve student employability in Bosnia and Herzegovina, with broader relevance for the South East Europe region, where similar transition economies face parallel challenges in aligning education with the demands of digitally transformed labor markets. The research utilizes a mixed-methods approach, integrating quantitative survey data from University of Sarajevo students with qualitative insights from industry professionals. Research indicates that the concurrent enhancement of soft skills (such as communication and critical thinking) and digital competencies, in conjunction with the utilization of AI tools, markedly enhances students’ preparedness for the contemporary labor market. The study emphasizes the essential role of autonomy in converting AI tool utilization into academic achievement and provides practical recommendations for educators, policymakers, and employers to address the skills gap in the digital economy.