University Clinical Hospital Mostar

Background/Objectives: Spontaneous intracerebral hemorrhage (sICH) is a particularly severe subtype of stroke, characterized by high rates of mortality and long-term disability, for which robust prognostic markers are still lacking. The aim of this study was to assess the relationship of the ICH score, the National Institutes of Health Stroke Scale (NIHSS) score, and serum high-sensitivity cardiac troponin I (hs-cTnI) levels with 30-day mortality in patients with sICH. Methods: We conducted a prospective observational cohort study enrolling 100 consecutive patients diagnosed with sICH based on neuroimaging findings. Demographic data, clinical parameters, neuroimaging findings, and serum hs-cTnI levels were collected on admission. Subsequently, the ICH score, its individual components, and the NIHSS score were assessed. Results: Patients who died were older and had significantly higher ICH and NIHSS scores, lower Glasgow Coma Scale (GCS) scores, larger hematoma volumes, more frequent intraventricular hemorrhage (IVH), and elevated hs-cTnI levels compared to survivors. Serum hs-cTnI concentrations were significantly correlated with ICH and NIHSS scores, lower GCS scores, larger hematoma volumes, and the presence of IVH. On univariate logistic regression, higher ICH score, NIHSS score, and hs-cTnI level were associated with mortality, whereas multivariate analysis identified the GCS score, hematoma volume, and IVH score as significant independent factors related to fatal outcome. Conclusions: Individual components of the ICH score may provide useful information on outcomes in patients with sICH. Higher serum hs-cTnI levels were associated with 30-day mortality but were not independent predictors. These markers may assist in patient monitoring and support established clinical procedures in therapeutic decision-making. Nevertheless, larger multicenter studies are needed to further clarify their clinical implications in sICH management.

IntroductionCoronary artery bypass grafting remains the preferred method for surgicalmyocardial revascularization. The use of extracorporeal circulation duringsurgery has been linked to myocardial damage and a systemic inflammatoryresponse. To mitigate these adverse effects, off-pump coronary artery bypassgrafting was introduced as an effective and safe alternative. However, thecomparison between these two procedures has yielded ambiguous results. Theaim of our study was to determine the differences in myocardial damage andthe intensity of the inflammatory response by measuring concentrations oftroponin, cardiac isoenzyme of creatine kinase, leukocytes, and C-reactiveprotein at multiple time points within the first 24 hourspostoperatively.MethodsThis single-center, prospective study involved 61 patients diagnosed withcoronary artery disease and divided into two groups based on the type ofsurgery performed.ResultsOur results indicated that coronary artery bypass grafting withextracorporeal circulation is associated with greater myocardial damage, asevidenced by higher levels of troponin and cardiac isoenzyme of creatinekinase. Additionally, extracorporeal circulation was linked to a morepronounced increase in leukocyte count postoperatively. Unexpectedly,C-reactive protein levels were higher in the off-pump coronary artery bypassgrafting group. There were no significant differences in hospital stay orin-hospital mortality between the two groups.ConclusionFurther research is necessary to clarify these controversies regarding thedifferences in systemic inflammatory responses between the two surgicalapproaches.

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis in infancy and the most frequent reason for hospitalization in the first months of life. While most infections follow a mild course, a proportion of infants develop severe disease requiring intensive care. Electrolyte disturbances, especially hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH), are a recognized complication and may trigger neurological symptoms. Severe hyponatremia with seizures is rarely documented in otherwise healthy term infants, which makes such cases clinically important. The aim of this report is to describe hyponatremia-induced seizures as a rare but clinically important complication of severe RSV bronchiolitis in a previously healthy infant. We report a 1-month-old previously healthy female infant who presented with cough, rhinorrhea, somnolence, and progressive respiratory distress. On admission, the infant developed generalized tonic seizures, and laboratory tests revealed profound hyponatremia with serum sodium of 113 mmol/L. RSV infection was confirmed by nasopharyngeal swab. The infant required transfer to the intensive care unit (ICU), where she was intubated and mechanically ventilated. Hyponatremia was managed with 3% hypertonic saline, and she received empiric antibiotics, later tailored to ceftazidime and amikacin, along with supportive therapy. Ventilatory support was required for 7 days. Neuropediatric assessment confirmed hyponatremia-related seizures, and no underlying neurological disorder was identified. After normalization of electrolytes and gradual clinical improvement, she was discharged after 20 days in good condition. This report highlights that RSV bronchiolitis can, in rare cases, present with profound hyponatremia and seizures even in previously healthy infants. Routine monitoring of serum sodium at admission, cautious use of intravenous fluids, and early recognition of neurological symptoms are essential to avoid serious outcomes. Awareness of this potential complication can help clinicians initiate timely management and prevent life-threatening consequences.

The COVID-19 pandemic introduced substantial changes to clinical practice, including widespread antibiotic use. These changes raised concerns about a potential rise in healthcare-associated infections, particularly Clostri dioi des difficile infection (CDI). This study aimed to investigate the hidden impact of COVID-19 treatment strategies on the incidence of CDI, with a specific focus on antibiotic use, advanced age, comorbidities, and the administration of proton pump inhibitors (PPIs) and corticosteroids. A retrospective observational study was conducted using anonymised patient data from the University Clinical Hospital Mostar. The number of CDI cases significantly increased during the COVID-19 peak in 2021, showing a perfect positive correlation with COVID-19 incidence (ρ = 1.0, p < 0.05). Antibiotic use was strongly associated with CDI (69 % vs. 12 %; p < 0.05), as was advanced age (≥ 65 years; 71 %; p < 0.05). The combined use of proton pump inhibitors and corticosteroids was significantly more frequent in the CDI group (54 % vs. 24 %; p < 0.05). The findings highlight how COVID-19 treatment strategies can unintentionally raise CDI risk, stressing the need for prudent antibiotic use, careful drug management and targeted prevention for elderly and high-risk patients.

Small-cell lung cancer (SCLC) is a tobacco-associated neuroendocrine tumor comprising ~15% of lung cancers (~150,000 cases/year). For decades, outcomes stagnated: most patients present with extensive-stage disease, screening rarely detects early tumors, surgery is seldom feasible, and platinum–etoposide remained the first-line standard with median overall survival (OS) <12 months. Radiotherapy (including consolidative thoracic RT) and prophylactic cranial irradiation or MRI surveillance offered incremental gains.Two shifts have begun to change the field. First, four transcriptional subtypes (SCLC-A, -N, -P, and inflammatory SCLC-I) support a more personalized approach, with SCLC-I appearing more responsive to immune checkpoint inhibitors (ICI). Second, adding atezolizumab or durvalumab to chemotherapy in extensive-stage SCLC produced a modest median OS gain but, crucially, a tail of long-term survivors. Subsequent trials extended these advances: IMforte suggested benefit from lurbinectedin maintenance with atezolizumab in ES-SCLC, and ADRIATIC demonstrated a landmark OS improvement (~22 months) with durvalumab consolidation after concurrent chemoradiotherapy in limited-stage SCLC.Targeted strategies are now emerging. Delta-like ligand 3 (DLL3), overexpressed in >80% of SCLC, enables T-cell–redirecting therapy: the bispecific T-cell engager(BiTE®)tarlatamab improved OS to 13.6 vs 8.3 months over standard second-line chemotherapy, with manageable cytokine release syndrome and occasional ICANS. B7 homolog 3 (B7-H3, CD276), uniformly expressed across SCLC subtypes and linked to poor prognosis, is another compelling target: the antibody–drug conjugate ifinatamab deruxtecan achieved a 54.8% response rate and meaningful survival in heavily pretreated patients, earning FDA Breakthrough designation.Together, DLL3- and B7-H3–directed therapies (with additional ADCs against Trop-2 and SEZ6 in development) are redefining second-line and later care. Key next steps include optimizing sequencing/combination strategies, managing BiTE® specific toxicities, and developing predictive biomarkers. After decades of futility, SCLC is transitioning from uniform chemotherapy to a precision-medicine paradigm with cautious optimism.

Inguinal hernia is a prevalent condition requiring surgical intervention, and accumulating evidence suggests that the type of anesthesia administered may influence systemic inflammatory responses. This study investigates the concentrations of inflammatory parameters in patients with inguinal hernia who underwent surgery utilizing either general or spinal anesthesia. The cohort comprised 87 male patients with inguinal hernia, classified as American Society of Anesthesiologists (ASA) physical status 1–2, who underwent elective surgical procedures. Participants were divided into two groups based on the anesthesia type: 44 received general anesthesia while 43 received spinal anesthesia. Plasma concentrations of leukocytes, C-reactive protein (CRP), interleukin-6 (IL-6), and lipopolysaccharide-binding protein (LBP) were quantified using automated immunoassays and a hematological analyzer. Standard parametric and non-parametric statistical tests were employed for data analysis, and the predictive capacity of select parameters, along with body mass index (BMI) and age, was assessed through Receiver Operating Characteristic (ROC) analysis with Area Under the Curve (AUC). Statistical analysis via the t-test identified significant differences in LBP concentrations (LBP 1, LBP 2, and LBP 3) between patients receiving general and spinal anesthesia. Correlation analysis of BMI and the measured parameters revealed statistically significant positive correlations for LBP 1 and LBP 2 in patients who underwent spinal anesthesia. Notably, the preoperative concentration of LBP, with a cutoff value exceeding 9.7 µg/mL, suggests a potentially superior approach with spinal anesthesia compared to general anesthesia, demonstrating 50% sensitivity and 81.4% specificity. Other parameters did not exhibit statistical significance in differentiating the type of anesthesia used for inguinal hernia surgery.

Herein, we aimed to analyze the final diagnosis in a well-defined cohort of fever of unknown origin (FUO) cases whose erythrocyte sedimentation rate (ESR) was 100 mm/h or more during the admission. The subgroup of the FUO patients with an ESR of 100 mm/h or more during the FUO evaluation, was extracted from the study database of a previously published multicenter study (European Journal of Clinical Microbiology & Infectious Diseases. April 15, 2023;42 (4):387-98). Data for 139 patients (17.6%, 139/788 of the original cohort) who fulfilled the study inclusion criteria, were obtained from 29 centers from 11 countries. Infections, neoplasms, and noninfectious inflammatory diseases were found to be the reason of fever in [n = 74 (53.2%)], [n = 14 (10%)], and [n = 13 (9.3%)] of 139 patients, respectively. Regardless of the diseases subgroup top 6 diseases that were determined to be the reasons of FUO were tuberculosis [n = 15 (10.8%)], HIV/AIDS [n = 13 (9.3%)], urinary tract infection [n = 9 (6.5%)], infective endocarditis [n = 9 (6.5%)], lymphoma [n = 9 (6.5%)], and abscess [n = 9 (6.5%)]. The most common infectious diseases were tuberculosis (15/74, 20.2%), HIV/AIDS (13/74, 17.5%), and infective endocarditis (9/74, 12.1%), along with urinary tract infection [n = 9 (6.5%)] and abscess [n = 9 (6.5%)]. The most common noninfectious inflammatory diseases were adult onset Still disease (3/13, 23%) and giant cell arteritis, also known as temporal arteritis (3/13, 23%), and followed by polyarteritis nodosa (2/13, 15.3%). The most common neoplasm was lymphoma (9/14, 64.2%), followed by lung cancer (2/14, 14.2%). Reason of fever could not be defined in (29/139, 20.8%) patients. The invasive procedures were performed in (64/139, 46%) patients. Gender, age > 50 or not, and income level (high-middle-low) of the participating country were not associated with a significant difference in the final diagnosis category of the FUO case (P > .05). To the best of our knowledge, this is the first study evaluating the FUO in the subgroup of cases with extreme ESR elevation and infectious diseases comprised the most cause of the FUO in this particular subgroup.

Acute appendicitis is one of the most common surgical conditions in pediatric and general surgery. The purpose of this study was to retrospectively investigate the management strategies of the appendiceal stump during transumbilical laparoscopic-assisted appendectomy for acute appendicitis in terms of surgical time, hospital length of stay, and postoperative complications. The records of patients < 18years of age who were treated for acute appendicitis at our Pediatric Surgery Unit from December 2018 to January 2024 were retrospectively reviewed. Data were extrapolated from the departmental database, and clinical notes were reviewed. The records of 278 patients who underwent appendectomy within a 5-year period at our institution were essentially used to compare appendiceal stump inversion and simple ligation. Appendiceal stump invagination was performed in 208 patients (74.8%), comprising 106 females (51.0%) and 102 males (49.0%), with a median age of 11years (IQR 8-15) and a median weight of 36.5kg (IQR 28-54). Twenty-six (12.5%) patients had associated conditions. The appendiceal stump was not invaginated in 70 children (25.2%), consisting of 26 females (37.1%) and 44 males (62.9%), with a median age of 11years (IQR 8-14) and a median weight of 38.3kg (IQR 29.5-47). Fourteen patients (20%) had associated pathologies. The two groups were similar in terms of sex (P = 0.05), age (P = 0.40), weight (P = 0.78), and associated pathologies (P = 0.12). Notably, 78.6% of appendicitis cases treated without stump invagination were uncomplicated, whereas 20% were complicated (4.3% abscess and 15.7% peritonitis cases). In contrast, stump invagination was performed in 87% of uncomplicated appendicitis and 13.1% of complicated appendicitis cases (6.8% abscess and 6.3% peritonitis cases). Therefore, simple ligation was also effective in complicated appendicitis cases (P = 0.03). In addition, the median surgical duration was 63.5min (IQR 46-90) for patients undergoing stump inversion and 69min (IQR 60-115) for patients undergoing simple ligation respectively (P = 0.02). Interestingly, statistical analysis revealed no significant differences in length of hospital stay (P = 0.21) and postoperative complications (P = 0.15). Simple ligation does not compromise treatment efficacy nor increase postoperative complications, nor the length of hospital stay.

Simultaneous uterine arteries and ovarian veins embolization as a management for chronic pelvic pain due to adenomyosis and pelvic venous disorders.