Impact of risk factors, early rehabilitation and management of lymphedema associated with breast cancer: a retrospective study of breast Cancer survivors over 5 years.

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a potentially disabling and often irreversible consequence of breast cancer treatment, caused by the mechanical incompetence of the lymphatic system, resulting in reduced drainage capacity and functional overload due to an excessive volume of interstitial fluid surpassing the system's transport capacity in the arm. We wanted to determine the impact and explore the differences in independent risk factors for the occurrence of BCRL; incidence of BCRL over a five-year period at the Institute of Oncology Vojvodina in Sremska Kamenica and to answer the research question regarding the influence of the prehabilitation program on the overall incidence of BCRL during the observed five-year period. METHODS: From 2014 to 2018, a retrospective study was conducted at the Institute of Oncology of Vojvodina in Sremska Kamenica, analyzing female patients who had undergone breast cancer surgery. RESULTS: The study included 150 breast cancer patients who developed secondary lymphedema following surgery with the mean age of 59.2 ± 11.3 years. Fluctuations in hospitalization rates were observed over the five-year period, with the highest number of admissions in 2014 (24.0%) and a decline in 2018 (14.0%). The most common surgical procedure performed was left quadrantectomy (24.0%), followed by right quadrantectomy (20.0%) and left amputation (15.3%). The mean number of removed lymph nodes was 15.2 ± 6.1, with no statistically significant association between the number of removed lymph nodes and the manifestation of secondary lymphedema. The severity of secondary lymphedema varied based on patient age, with a higher incidence of moderate and severe lymphedema observed in patients aged 61 years and older. Patients who underwent radical surgery were more likely to experience severe lymphedema compared to those who had conservative surgery, although this difference was not statistically significant. CONCLUSION: In our study, the type of surgery, elapsed time since surgery, and the number of removed lymph nodes were not influencing factors for the occurrence of BCRL. However, concerning its severity, a greater number of systemic therapy modalities combined with radiotherapy were associated with a more frequent occurrence of mild and moderate BCRL. Also, the severity of BCRL varied among different age groups, with a higher incidence of moderate and severe lymphedema observed in patients aged 61 years and older. Ultimately, improving the quality of life for individuals affected by secondary lymphedema remains a crucial goal in the field of oncology.

Comparison between conventional open-heart valve surgery and minimally invasive valve replacement surgery regarding the length of hospital stay and usage of blood derivates: insights from a single-centre, single-surgeon study conducted in Bosnia and Herzegovina.

Aim To analyse the correlation between different surgical methodologies employed in valve diseases treatment and their subsequent impact on the duration of hospitalization. Methods This retrospective study conducted at the Clinical Centre of the University of Sarajevo analysed medical records of 163 valve disease patients treated between January 2019 and November 2022. The patients were divided into two groups: 77 had openheart valve surgery and 86 underwent minimally invasive cardiac surgery (MICS). Results The mean duration of the surgical procedures was 3.9±1.3 hours, with conventional open-heart surgery requiring an average of 3.6±1.1 hours and minimally invasive cardiac surgery (MICS) procedure 4.2±1.5 hours. No substantial disparities were found in the total length of hospitalization between the two groups, as both conventional (8.2±4.5 days) and MICS (8.7±7.0 days) demonstrated similar duration. Similarly, the total duration of intensive care unit (ICU) stay displayed similarity, with conventional surgery patients staying an average of 3.9±2.8 days and MICS patients of 4.2±4.1 days. The pattern of blood transfusion and fresh-frozen plasma usage revealed higher rates in the conventional valve surgery group comparing to the MICS group. Conclusion Minimally invasive valve surgery, despite slightly longer operative times, resulted in lower blood transfusion requirements and comparable hospitalization and ICU stay.

The Role of Resilience in the Relationship between Sociodemographic, Clinical Characteristics, and Social Support among Breast Cancer Patients in Serbia.

BACKGROUND: The management of breast cancer treatments within the limitations of family, social, and professional life is emotionally burdening and negatively affects physical, psychological, and social well-being, reducing the overall quality of life of patients and their families. METHODS: This cross-sectional descriptive-analytical study was conducted from March to August 2023 at the "Dr. Radivoj Simonovic" General Hospital in Sombor. A total of 236 breast cancer patients participated in this study. The research was conducted using the following instruments: a questionnaire on sociodemographic and clinical characteristics of patients, the Berlin Social-Support Scales-for assessing social support-and the Connor-Davidson Resilience Scale-for assessing resilience. This study aimed to determine the predictors and levels of social support and resilience of breast cancer patients. We also wanted to examine whether resilience is a mediator between patients' sociodemographic and clinical characteristics and levels of social support. RESULTS: The total average value of social support was 3.51 ± 0.63, while on the resilience scale, the respondents achieved a total average score of 52.2 ± 9.63. Perceived and actually received social support of breast cancer patients were positively correlated with resilience [p < 0.01], while no statistically significant correlations were found for the need for support and satisfaction. The sets of predictors can significantly predict their effects on all types of perceived social support (emotional social support: 9%; perceived instrumental social support: 9%) and all types of received social support (actually received emotional social support: 8%; actually received instrumental social support: 7%; actually received informational social support: 8%). There is a potential mediating role of resilience in relation to sociodemographic factors, clinical characteristics, and the need for support. CONCLUSION: This study confirms that a strong connection exists between social support and resilience. However, the analysis did not confirm the mediating role of resilience between the sociodemographic and clinical characteristics on the one hand and social support on the other.

Minimally invasive coronary artery bypass (MICS CABG) in Bosnia and Herzegovina: a single centre, single surgeon cohort experience.

Aim This is the first research in Bosnia and Herzegovina presenting minimally invasive coronary artery bypass grafting surgery (MICS CABG) experience, advantages, and outcomes as compared to conventional surgery (OPEN CABG). Methods This retrospective cross-sectional study was conducted between January 2019 and November 2022 and included patients with indication for surgical revascularization. Results Among 237 patients, males predominated, 182 (76.7%), with a mean body mass index (BMI) of 28.4±3.9, median The Society of Thoracic Surgery Risk (STS) score of 1.55 (0.8, 4.0), short term STS score of 11.2 (6.8, 23.7), mean age of 64.8±8.7 (ranging 41-83) years, 122 (51.4%) underwent OPEN CABG and 115 (48.6%) MICS CABG. MICS CABG took less time (p<0.001; OPEN 3.5±0.8h; MICS 2.8±0.8h) and needed less mechanical ventilation (p<0.001, OPEN 17.3±11.9h; MICS 13.0±12.5h) than OPEN CABG. Even though there was no difference in hospitalization length between groups (OPEN (7.5±3.2), MICS (7.1±4.0)), patients receiving MICS (2.9±1.5) spent less time in the ICU (p=0.0013) than OPEN CABG (3.6±2.8). OPEN CABG used also more blood derivatives, red blood cells (OPEN 292 vs MICS 55), plasma (OPEN 270 vs MICS 86) and platelets (OPEN 71 vs MICS 28). Conclusion Patients undergoing MICS CABG in Bosnia and Herzegovina had less mechanical ventilation hours and less ICU duration compared to OPEN CABG even though the hospitalization duration was very similar. MICS CABG takes less time to be conducted, has fewer CPRs postoperatively, uses less blood derivatives including red blood cells, plasma and platelets.

Cervical Cancer Prevention Knowledge (Cckp-64) among Female Students in Novi Sad, Serbia during COVID-19 Pandemic.

Cervical cancer is a significant global health concern affecting young women, with over 500,000 new cases reported annually. This questionnaire-based study aimed to evaluate the knowledge of cervical cancer prevention among female students at the University of Novi Sad during the COVID-19 pandemic using the Cervical Cancer Knowledge Prevention-64 (CCKP-64) tool. The study sample consisted of 402 predominantly 20-22-year-old female students from either social or technical science faculties in urban environments. Results revealed that out of the 402 female students involved in the study, most had a good general knowledge of primary prevention of cervical cancer, with a correct answer rate ranging from 29.9 to 80.6%. On the contrary, only 63.4% of female students have heard about the vaccine against cervical cancer; 52.0% know that the vaccine exists in Serbia; and 31.8% know where to get vaccinated. Only a small proportion of students (9.7%) have encountered cervical cancer among their relatives/friends and think that the disease could affect them in the future (25.4%). Older students (>26 years) generally (p < 0.05) had better knowledge regarding distressing symptoms of cervical cancer, cytological examination and secondary prevention; however, it was also noted that a significant percentage of this age group reported not having received vaccinations (53.0%, p = 0.001). This study underscores the need for increased awareness and education about the HPV vaccine and secondary prevention among young women in Serbia. Future research should investigate knowledge and attitudes toward cervical cancer prevention in diverse populations to develop effective interventions and strategies. These findings have implications for public health policies in Serbia to promote cervical cancer prevention among young women.

Pericardial Effusion in Postcoronavirus Disease Patients with Preserved Ejection Fraction of the Left Ventricle and Normal Values of N-Terminal-Pro B-Type Natriuretic Peptide-Link with C-Reactive Protein and D-Dimer.

Aim: The aim of this study was to link the values of D-dimer and C-reactive protein (CRP), with the occurrence of pericardial effusion in patients who had coronavirus disease 2019 (COVID-19) and have preserved systolic function of the left ventricle (LV). Methods: This was a prospective study and included 146 patients who underwent echocardiographic examination 30 days after the acute phase of COVID-19. Patients who were placed on mechanical ventilation, patients who had pulmonary thromboembolism or acute coronary syndrome during the acute period of the disease, patients who had an ejection fraction of the LV <50%, patients who were diagnosed with pericarditis during acute illness or clinical signs of heart failure (or had elevated N-terminal-pro hormone B-type natriuretic peptide value), with verified renal or hepatic dysfunction were excluded from the study, including patients with diabetes mellitus Type 1, patients with cancer, connective tissue disease, or pregnant women. The existence of cardiovascular risk factors (hypertension, diabetes mellitus Type 2, and hyperlipidemia), the presence of previous ischemic heart disease, maximum values of D-dimer, and CRP (during the first 15 days of the disease) was taken into the analysis. Results: Effusion was verified around the right atrium (RA) in 104 patients (3.85 ± 1.75 mm), in 135 patients next to the free wall of the right ventricle (RV) (5.24 ± 2.29 mm), in front of the apex of the LV in 27 patients (2.44 ± 0.97 mm), next to the lateral wall of LV in 35 patients (4.43 ± 3.21 mm), and behind the posterior wall of LV in 30 patients (2.83 ± 1.62 mm). Mean CRP values during the acute phase of the disease were 43.0 mg/L (8.6-76.2 mg/L), whereas D-dimer mean value was 880.00 µg/L (467.00 -2000.00 µg/L). CRP values correlated with effusion next to the free wall of RV (rho = 0.202; P = 0.018). The D dimer correlated with effusion around RA (rho = 0.308; P = 0.0001). Conclusion: The clinical picture of the post-COVID patients could be explained by the appearance of pericardial effusion. D-dimer value correlates with the occurrence of effusion around RA, whereas CRP value correlates with effusion next to the free wall of RV.

Epidemiological Aspects of Age and Genotypical Occurrence of HPV Infection Among Females of Canton Sarajevo Over a 10-year Period.

Background: Human papillomaviruses (HPV) are one of the most prevalent causes of cervical, anal, and oral cancer, and it is believed that nearly all sexually active males and females have been infected with HPV at some point in their lives. Objective: The purpose of this study is to highlight epidemiological characteristics of the age and genotypical incidence of HPV infection among females in Canton Sarajevo during a 10-year period. Methods: This cross-sectional study was conducted in the period between January 2012 and December 2021 at the medical institutions "Zavod za Ginekologiju, Perinatologiju i Neplodnost "Mehmedbasic" among females who were admitted for a routine gynaecological exam in Canton Sarajevo in Bosnia and Herzegovina. Results: In total, 1517 patients who reported typical sexarche at 18.35±1.92, having one 721 (47.5%) sexual partner, regular use of contraceptive methods 820 (54.5%) with male condom 513 (62.6%) being the dominant choice of contraception and having gynacological hereditary oncological positive history 141 (9.3%), were included in the study from which 653 (43.05%) patients had positive HPV test and 864 (56.95%) had negative HPV results. HPV positive patients, 386 (59.1%) were infected either with one type of virus only, while 267 (40.9%) patients were infected with multiple virus strains where we have identified 166 virus strain combinations. Analysis showed that the patients infected by only one virus strain were one of next specific HPV viruses: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68. HPV-16 was the predominately strain 16 (22.5%) identified among all the patients. Mean age of HPV positive patients was 33.38±7.85, ranging from 18 to 61 years. Conclusion: This study highlights the significance of the most frequent HPV high-risk strains (HPV-16, -18, -31.-33,-45,-52, and -58) among the Bosnia and Herzegovina population as one of the most common cancer-causing strains worldwide.

ABO groups as a risk factor for myocardial infarction in the population of Bosnia and Herzegovina.

Aim To investigate the association of ABO blood types and appearance of myocardial infarction (MI) among the population in Bosnia and Herzegovina. Methods This was a cross sectional study conducted at the Department for Cardiovascular Surgery at the Clinical Centre of the University of Sarajevo from January 1st to December 31st 2019. Patients were divided into two groups, defined by their blood type, A (N=91) and non-A (N=109). ABO blood groups were determined using standard agglutination techniques. Information regarding history of MI was taken from their medical documentation during the preparation for surgery. Results In total 200 patients were involved in this study. The study sample consisted of 151 (74.5%) males and 49 (25.5%) females. Mean age was 62.98 ± 7.73. Various risk factors associated with myocardial infarction were tobacco 92 (46.0%) and alcohol 54 (27.0%) consumption, obesity 77 (38.5%), diabetes mellitus 47 (23.5%) and hypertension 91 (45.3%). Being A blood type (OR=3.308; 95% Cl 1.317-8.311; p=0.011) and being male and having hypertension (OR=3.086; 95% Cl 1.262-7.545; p=0.013) significantly increased the risk for the development of MI among young adults. Patients with A blood type were significantly younger [median 58.0 vs. 63.0; U = 2738.5; p =0.027] when they developed MI compared to non-A blood type. Conclusion The age of myocardial infarction occurrence in the population of Bosnia and Herzegovina is lower in patients with blood group A compared to non-A blood types.

Lifestyle risk factors and comorbidities of cancer patients in a country with limited resources.

Aim To investigate quality of life and exposure to lifestyle risk factors of cancer patients in Bosnia and Herzegovina and a correlation of cancer type with lifestyle risk factors. Methods This was a cross-sectional study conducted on 200 cancer patients from the Clinical Centre of the University of Sarajevo. The respondents completed an anonymous questionnaire consisting of seven sections: basic patient information, physical activity, dietary habits including alternative medicine, tobacco use, alcohol consumption, anxiety, and comorbidities. Results A total of 150 (75%) patients were overweight with 113 (56%) of them being less physically active after the confirmed diagnosis. After the diagnosis, 79 (40%) patients ate less food, and 154 (77%) healthier; 130 (65%) reported consumption of alternative medicine and food supplements, 39 (30%) spent >1/4 of average monthly salary on these products. Majority never consumed alcohol, 135 (68%) and 101 (51%) patients reported history of tobacco use. Being obese was an independent predictor for colorectal carcinoma; being less obese was linked to a decreased risk of breast cancer diagnosis. Physical activity was linked to a decreased risk of lung cancer diagnosis. Many patients (122; 61%) reported having chronic comorbidities, mostly hypertension, while 44 (22%) patients were proven to be clinically anxious. Conclusion Our data suggest lack of public awareness of the consequences of unhealthy lifestyles. Risk factors such as alcohol consumption and tobacco use differed from other European countries. Significance of lifestyle changes after the diagnosis for reducing mortality and cancer recurrence requires further research. Prevention programs and more data are needed.