Background: Cholelithiasis is one of the most common issues affecting the gastrointestinal tract. The prevalence of cholelithiasis ranges from 11% to 36%. The prevalence is found to be associated with a number of factors including age, gender and ethnicity. Women have three times higher risk of developing this condition in comparison to men. Objective: This The aim of this study is to prove that occurrence of early and late postoperative complications is lower in patients who had three metal clips placed on cystic artery and ductus cysticus in comparison to the patients who had two metal clips placed. Methods: In this retrospective study we included all the patients who underwent acute laparoscopic cholecystectomy between January 1st 2021 and December 31st 2022 at the Department of Abdominal Surgery of University Clinical Centre Tuzla. Total number of patients included in the study is 148. A total of 1200 laparoscopic cholecystectomies were performed, of which 1052 patients had chronic calculus cholecystitis, and the performed laparoscopic cholecystectomies were part of elective surgical procedures. Remaining 148 patients had acute calculus cholecystitis, and were admitted and operated laparoscopically in an emergency protocol. Results:: Out of total amount of 82 laparoscopic surgeries were performed with the placement of two clips on the cystic artery and cystic duct, and 66 laparoscopic cholecystectomies with the placement of three clips on the cystic artery and cystic duct. Out of a total of 82 patients who were implanted with two clips, 6 of them had some of the postoperative complications. In the group of patients who had three clips implanted, none of the 66 subjects had any postoperative complications. Conclusion:: The study confirms that patients who underwent placement of three clips had lesser odds of developing complications, and that this occurrence is not accidental but rather a consequence of the choice of the surgical method.

Introduction: Colorectal cancer (CRC) is one of the most common malignancies with significant global health and economic implications. Genetic mutations in genes such as TP53, APC, KRAS, and MMR play a crucial role in the development and progression of this cancer. This review paper analyzes current knowledge about the impact of these mutations on colorectal carcinogenesis, using available literature. Objective: To provide a comprehensive review of the role of genetic mutations in TP53, APC, KRAS, and MMR genes in the development of colorectal cancer and to consider their impact on diagnosis and treatment. Materials and Methods: This review examines peer-reviewed research articles and reports sourced from databases such as PubMed, Google Scholar, and other academic sources. The focus was on studies investigating genetic mutations, their prevalence, and their role in the pathogenesis of CRC. Results: Mutations in the TP53 gene, present in more than 50% of CRC cases, are critical for malignant cell transformations. KRAS mutations, found in about 50% of cases, lead to abnormal signaling contributing to unchecked proliferation. APC mutations are associated with hereditary predisposition to CRC, while MMR genes, such as MLH1 and MSH2, play a key role in DNA repair and are linked to hereditary nonpolyposis colorectal cancer. Conclusion: Genetic mutations in TP53, APC, KRAS, and MMR genes play a significant role in the development of colorectal cancer. A deeper understanding of these mutations may significantly enhance diagnostic and therapeutic strategies, guiding future research in this rapidly evolving field.

Introduction: Breast cancer, the most common malignancy in women, represents a significant health issue, and biomarkers such as the Ki-67 index and uPA/PAI-1 complex can provide insight into treatment outcomes and therapeutic response. Objective: The primary outcome of the study was the assessment of 5-year disease-free survival (DFS), defined as the postoperative period until the occurrence of loco-regional or distant metastases and death from any cause. Patients and Methods: A retrospective cohort study included 166 patients with early invasive breast cancer, in whom the prognostic and predictive significance of the uPA/PAI-1 complex and Ki-67 biomarkers in surgically treated patients at the Clinic for General and Abdominal Surgery of the University Clinical Center in Sarajevo was evaluated during the period from September 2015 to February 2017. Results: Univariate regression analysis identified an increased probability of DFS shorter than five years in patients with negative hormone receptors, positive HER-2 receptor, ≥ 8 positively mph nodes, and a Ki-67 index ≥ 14% (p < 0.05). Multivariate regression analysis revealed that T2 stage, tumor size of 20-50 mm, and a Ki-67 index ≥ 14% were associated with a higher probability of DFS shorter than five years (p < 0.05). The five-year DFS rate was higher in patients with a Ki-67 index < 14% compared to those with ≥ 14% (p = 0.011), while there was no difference in five-year DFS among patients with different levels of the uPA/PAI-1 complex (p = 0.636). Conclusion: Our study highlights the importance of the Ki-67 proliferative index as a strong prognostic and predictive factor for DFS in patients operated on for early invasive breast cancer. Additional monitoring and tailored therapeutic strategies may be beneficial in patients with elevated Ki-67 index values, T2 stage, and tumor size of 20-50 mm.

Working with various tools is demanding and can also be very dangerous. Many standards regulate this area, including ISO 45001:2018. Workplace injuries and illnesses significantly burden employers and impact the economy in general, which has led to the development of this important standard. Additionally, many companies have internal work instructions for using specific tools to protect the health and lives of individuals. Forklifts are such tools that require personnel to be trained in their operation to ensure the protection of themselves and others. This paper presents the operational instructions for handling forklifts at the Zenica Steelworks, which have been in place for a considerable period and can serve as a model for other manufacturing or service companies.

Background: Autoimmune limbic encephalitis (ALE) is an inflammatory brain process involving a group of diseases with antibodies against neuronal synaptic and cellular antigens. Diagnosis is based on clinical examination, neurological functional tests, cerebrospinal fluid analysis, immunological testing, and radiological findings. Objective: This case report aims to present the case of a 68-year-old patient initially hospitalized for intermittent neurological deficits in the form of cognitive disorders of consciousness, which was initially declared as dementia without physical neurological deficit. Case presentation: Initial brain MRI (SIEMENS Magnetom Avanto, 1.5 T, Erlangen, Germany) showed changes differentially diagnosed characterised as glial neoplasm of mixed-grade astrocytoma or inflammatory process of unilateral autoimmune encephalitis. Since the neurosurgical opinion suggested a higher-grade glioma with proposed surgical treatment, the patient was referred for repeated MRI with MR spectroscopy in order to exhaust all diagnostic possibilities before surgery. MRI with MR spectroscopy (SIEMENS Magnetom Lumina, 3 T, Erlangen, Germany) revealed radiologically altered findings, in the right hippocampus and parahippocampal gyrus, which primarily corresponded to changes due to unilateral autoimmune encephalitis,due to its morphology characteristics and spectroscopy profile, making the primary glial neoplasm of lower grade less likely. Since the neurological mosaic IIFT result showed a positive LGI1 antibody finding, therapy for autoimmune encephalitis was initiated, leading to significant improvement in cognitive functions and the return of short-term memory. Conclusion: Although the detection of antibodies against onconeural, cellular, and synaptic proteins represents a significant advancement in diagnosing autoimmune limbic encephalitis, the role of conventional diagnostic tools such as MRI, EEG, and cerebrospinal fluid analysis should not be overlooked, where the application of new functional imaging techniques such as MR spectroscopy can be beneficial and should be considered.

Background: In the year 2024 Bosnia and Herzegovina celebrates anniversaty of three important healthcare institutions: the Vaqf's hospital in Tuzla established in 1874, Regional hospital in Sarajevo (Landesspital) established in 1894 and the first Faculty of Medicine in Bosnia and Herzegovina established in Sarajevo in 1944. Objective: The aim of this article was to describe historical facts how mentioned institutions were founded and what was importance of functioning all of them during history of health care education and healthcarte protection. Methods: The author searched important historical facts about establishing and works Hastahana in Tuzla, Landesspital in Sarajevo and Medical faculty in Sarajevo, writen in the books and articles deposited in indexed databases PubMed Central, Scopus, Hinari, Embase, etc. Results and Discussion: The first hospital (hastahanas, named as Waqf's hospitals, besides other 4 - established in Tuzla, Mostar, Travnik and Banja Luka) has been founded in Sarajevo in 1866, which was founded by Governor Serif Osman Topal Pasha and doctor Jozef Kecet. These hastahanas were definitely the embryo of an organized health services in Bosnia and Herzegovina, which have had enormous hystorical significance. Vakuf's hospital in Tuzla (Hastahana) founded by doctor Mehmed Serbic Sami, the first Muslim physician, graduated in Instanbul, Turkey at Lecole de Medicine in 1873. The first official hospital established during Austrian-Hungarian period was Regional (Landesspital) hospital opened in the July 1st 1894 and had 303 hospital beds in 4 departments: the first Internal department with diseases of the throat and nose (not the ear) with 45-50 beds, the Second - Surgical Department with ophtalmology (for ear surgery) with 45-50 beds, the Third - Dermatology and Venerology ward with 70-80 beds and the fourth - Gynaecology-obstetrics department with 70-80 beds. It will be a good basis for training future teachers pioneers of medicine, which will be opened in Sarajevo in November 22nd 1944 as a part of Medical Faculty in Zagreb. An generation of medical students attend the first year of study in Sarajevo. True, most students of this generation will be mobilized during the war, some will move on to medical faculties in other cities, and some other faculties in Sarajevo. The first Faculty of Medicine in Bosnia and Herzegovina officialy established in November 16th 1946. Conclusion: All institutions described in this article played important role in the history of healthcare education and healthcare protection in Bosnia and Herzegovina.

Background. The novel SARS-CoV-2 virus initiated one of humanity’s biggest pandemics, swiftly spreading worldwide and inducing significant health issues. This virus prompted widespread changes, with initial inadequate immune response and a lack of effective drug therapies. Consequently, every organ, particularly the respiratory and nervous systems, was susceptible to infection. The Covid-19 pandemic ended in 2023, but ongoing symptoms led to the term Long Covid and chronic manifestations. Objective: The aim of this article was to describe the important role of health professionals, especially family physicians and their teams when and how to identify common neurological symptoms and clinical conditions during pandemic and post-pandemic period. Methods. A systematic review gathered data on neurological symptoms and complications in Covid-19 patients, ranging from mild, like headache, to severe, such as encephalitis and stroke. Results and Discussion. Analysis revealed a significant proportion of Covid-19 patients experiencing neurological manifestations, with about one-third exhibiting symptoms. Epidemiological data showed ongoing Long Covid symptoms alongside acute manifestations. Many of cases with Long Covid related neurological complications were presented. Common neurological manifestations included chronic fatigue, changes in smell and taste, brain fog, headaches, fibromyalgia, cognitive impairment, and mood disorders. Severe Covid-19 cases were more likely to exhibit neurological complications, such as ischemic brain vasculitis and thromboembolic events, associated with higher mortality rates. Neurological complications of Covid-19 are frequent and diverse, necessitating a multidisciplinary approach in diagnosis and treatment, coordinated by primary care physicians. In practice, it is necessary to monitor the patient’s immune status over a longer period, and coagulation disorders (D-dimer) for adequate therapy and rehabilitation. Very important is to recognize the immune response after an acute infection. Due to the epidemic occurrence of Long Covid, it is necessary to introduce the above-mentioned procedures also in case of clinical signs of Long Covid. There are several hypotheses for the causes of Long COVID symptoms, including immune disorders, persistence of the virus in various organs, and microvascular coagulation changes. Within primary healthcare as the first line of defense it is necessary to address stress caused by COVID-19, try to recognize the affected other organ systems. Conclusion: The family doctor with his communication skills can make connection with the secondary and tertiary levels and the consulting services of immunologists, microbiologists, nutritionists, pharmacist, physiatrist and infectiologist. The family medicine team plays a key role in prevention, random detection and adequate medical procedures. The main interventions at the primary level should include education, emotional support, specific nutrition interventions and lifestyle modifications.

This publication has always been a cornerstone of our community, providing valuable insights, updates, and a platform for sharing the incredible work of our members. It was initiated during the EFMI presidency of Catherine Chronaki (Belgium, Greece), with our enthusiastic colleague, Izet Masic (Bosnia Herzegovina), serving as the first Editor-in-Chief. The past year has been a period of reflection and rejuvenation for our team. We took this time to evaluate how best to serve you, our esteemed members, and ensure that our newsletter remains a vital resource in our professional journey together. We continue the traditional general content of previous editions, introducing a structural organization by sections, each coordinated by a guest editor. Additionally, we have expanded the range of topics, introducing articles on opinions as well as including some highlights from our previous meetings. This edition features three special sections.

Introduction: Doping which includes veterinary drugs as irrational human medicine after the infection with COVID 19 still leaves the field open from the aspect of vascular surgery and angiology of the iliac segment. Reflection of the effect of the COVID 19 virus on the sports performance of athletes in various sports after the corona virus is still present. Some athletes have had a hard time individually coping with the clinical consequences after a long illness of the COVID 19 virus. Even though covert doping is part of the everyday life of an elite athlete, it still remains an unresolved topic in the form of a solution for post-COVID 19 symptoms or switching to or taking some other masked substances that are impossible to detect in the blood, as well as a potential reflection on the morphological changes of the arteries. Although consequences of the corona virus for the cardiorespiratory system have been reported, a question arises as to the connection between the development of iliac syndrome and pathomorphological arterial iliac changes in athletes with suspicion of potential correlation with underground doping substances of pharmacologically untested origin in the Balkan population. Widespread global COVID 19 pandemic and the isolation factor have forced numerous athletes to switch their normal training routine and protocols to alternatives such as cycling with or without abusing illegal substance. Increased intima-media thickness, the first structural change detected in atherosclerosis, is an important surrogate marker in atherosclerosis can be connected with high intensity endurance cyclists, running and triathlon competitive athletes affecting their poor performance status and professional doping levels. In some cases, amateur and recreational athletes are also affected especially if they were exposed to COVID 19 infection and doping. Goals: The primary focus of the present study is to determine the initial progression of the disease during and after the COVID 19 pandemic, starting from morphological changes and obstructive arteriopathy of the external iliac artery on account of measuring intima media thickness and the possibility of outset of kinking and obstructive arterial disease of the external iliac artery after 3 years. The secondary focus of the study is to examine the influence of doping on the pathomorphological changes of the external iliac artery during 3 years of research. Subjects and Methods: two groups of were observed (recreational and amateur cyclist). In total 63 selected subjects in the demographic area of ​​former Yugoslavia without cardiovascular disease were observed during the January 2021 and January 2024 period (3 years). Results: Changes in intima-media thickness of iliac artery from baseline 3 years were observed between the standard exercise amateur group and recreational control group. However, intensity exercise under 9000km per year were no significant developing progression of intima-media thickness of iliac artery during 3 years in recreational control group, but minimal progression of intima-media thickness of iliac artery were significant in amateur cycling group due to the potential effect of doping. Conclusion: The application of doping itself is indisputable, but the missing link that would confirm this claim is scientifically limited. We cannot confirm with certainty what is the trigger for the progression of pathomorphological changes and whether the consequences of overcoming the COVID 19 infection or doping. But there are many scientific facts and studies that confirm the connection between progressive atherosclerosis and illegal underground doping substances of pharmacologically untested origin. The consequences may result with a tendency for a futuristic vascular invasive patch or bypass surgical treatment.

The article presents an approach to the automatic derivation of conceptual database models from heterogeneous source artifacts. The approach is based on the integration of conceptual database models that are derived from source artifacts of one single type by already existing tools, whereby those models possess limited certainty given their limited completeness and correctness. The uncertainty of the automatically derived models from specific source artifacts is expressed and managed through the effectiveness measure of the generation of specific concepts of the input conceptual database models. The approach is implemented by the DBomnia tool - the first online web-based tool enabling automatic derivation of conceptual database models from heterogeneous source artifacts (business process models and textual specifications). DBomnia employs other pre-existing tools to derive conceptual models from sources of the same type and then integrates those models. The case study-based evaluation proves that the implemented approach enables effective automatic derivation of the conceptual database model from a set of heterogeneous source artifacts. Moreover, the automatic derivation of the conceptual database model from a set of heterogeneous source artifacts is more effective than each independent automatic derivation of the conceptual database model from sources of one single type only.

Background. Endoscopic Retrograde Cholangiopancreatography (ERCP) is an essential procedure for diagnosing and treating biliary and pancreatic disorders but carries the risk of significant complications, particularly in patients with pre-existing conditions. The most critical complications include acute pancreatitis, bleeding, perforation, and cholangitis. Early detection and comprehensive therapeutic interventions are key factors in patient recovery and require seamless communication among healthcare professionals at all levels of care. Close collaboration between medical staff ensures a well-coordinated treatment strategy, even at the primary care level. Objective: This article aims to present a case of a patient who developed multiple severe complications following ERCP, including ulcer perforation with pneumoperitoneum, acute pancreatitis, cholangitis, and cardiac decompensation, all of which were successfully managed within an outpatient and family medicine setting. Methods and Design: The patient’s clinical history, laboratory findings, radiological imaging, and endoscopic evaluations were carefully analyzed and described to outline the approach to diagnosis and management. Case Presentation: An 86-year-old male with a known history of peptic ulcer disease opted for outpatient treatment after undergoing an ERCP procedure. The patient subsequently developed a series of severe complications, including ulcer perforation, pneumoperitoneum, acute pancreatitis, and cholangitis, along with cardiac decompensation. However, through meticulous outpatient management and primary care follow-up, the patient achieved a favorable recovery. Conclusion: This case report highlights that comprehensive outpatient management can effectively address complex complications following ERCP, even in patients with pre-existing conditions. Coordinated care at the primary healthcare level plays a vital role in ensuring positive outcomes.