Differences in Outcomes Between Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Metastatic Breast Cancer Patients in Upper Middle-Income versus High-Income Countries: A Retrospective Study from 4 Oncology Centers.

BACKGROUND Therapeutic options for human epidermal growth factor 2 (HER2)-positive metastatic breast cancer (mBC) are developing rapidly. This study aimed to determine the differences in the survival outcomes of patients with HER2-positive mBC in relation to access to anti-HER therapy at 3 oncology centers in upper-middle-income countries (UMICs) and 1 oncology center in a high-income country (HIC). MATERIAL AND METHODS We retrospectively identified 42 patients from Croatia (HIC), 71 patients from Serbia (UMIC), and 57 from Bosnia and Herzegovina (UMIC) diagnosed with HER2-positive mBC who were treated between January 2015 and December 2020. The pathohistological features of the tumors were obtained from the pathological findings, which were made according to standard procedures for each center. Patients were treated depending on the availability of therapy, which differed for centers in different countries. We evaluated disease-free survival, progression-free survival, and overall survival (OS) based on the availability of first- and second-line anti-HER2 therapy in UMICs vs HIC. RESULTS OS in first-line therapy was better in patients treated with dual HER2 blockade than in patients treated without dual HER2 blockade, P<0.001. OS in second-line therapy was significantly better in patients treated with trastuzumab emtansine than in patients treated with other reported regimens, P=0.004. CONCLUSIONS Results of our study showed superior survival among patients who were treated with dual first-line HER2 therapy as well as second-line trastuzumab emtansine therapy than in those patients in other centers where these drugs were not available. Raising awareness about this could help improve the situation.

Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology Clinic of University Clinical Hospital Mostar, Bosnia and Herzegovina: A Cross-Sectional Study.

BACKGROUND The pandemic of Coronavirus infectious disease 2019 (COVID-19) poses a major public health challenge, and an effective vaccine is the potential mechanism to resolve this specific situation. The present study aimed to evaluate acceptance of COVID-19 vaccination among patients attending the Oncology Clinic of University Clinical Hospital Mostar. MATERIAL AND METHODS This cross-sectional observational study enrolled 364 patients with cancer from the Oncology Clinic of University Clinical Hospital Mostar during February 2021. Data were collected using a questionnaire that captured general information about the participants and their attitudes toward COVID-19 vaccination. RESULTS Of the participants, 41.8% answered "Yes" when asked if they would take the vaccine once it becomes available, 37.6% answered "Not sure", and 20.6% answered "No". For patients in favor of vaccination, the main reasons reported were fear of getting sick (77.6%), the desire to contribute to herd immunity (57.8%), and trusting the recommendations of health professionals (57.2%). The main reasons for the patients' vaccination -refusal/indecision were doubts about the results from clinical trials of COVID-19 vaccines (49.1%), concerns about adverse effects (24.5%), and confusion about the various vaccine options (19.8%). The majority of participants (82.4%) stated that recommendation by their oncologist could influence their decision about vaccination. Of the participants who indicated unwillingness (refusal or indecision) to be vaccinated against COVID-19, 65.3% stated that recommendation by their oncologist could influence their decision about vaccination. CONCLUSIONS The findings from the present study showed most patients had refused or were indecisive regarding immunization with COVID-19 vaccine. Increasing physician awareness of this situation may result in higher rates of vaccination.

Use of the Depression, Anxiety and Stress Scale (DASS-21) Questionnaire to Assess Levels of Depression, Anxiety, and Stress in Healthcare and Administrative Staff in 5 Oncology Institutions in Bosnia and Herzegovina During the 2020 COVID-19 Pandemic.

BACKGROUND Providing oncology services during a pandemic can contribute to mental health challenges among healthcare workers. The present study aimed to evaluate the levels of depression, anxiety, and stress in healthcare and administrative staff in 5 oncology institutions in Bosnia and Herzegovina (BiH) in 2020 during the coronavirus disease 2019 (COVID-19) pandemic using the Depression, Anxiety and Stress Scale (DASS-21) questionnaire. MATERIAL AND METHODS A cross-sectional observational study enrolled 175 healthcare and administrative workers from 5 oncology institutions in BiH during December 2020. Data were collected using a questionnaire that captured general information about the participants and a DASS-21 questionnaire. RESULTS Statistical analysis revealed a statistically significant difference in the levels of depression, anxiety, and stress (P=0.003, P=0.011, and P=0.022, respectively) among participants with comorbidities connected with increased risk of severe illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with participants without comorbidities. There was also a statistically significant difference in the levels of stress among participants from different cities (P=0.031). Supplement intake and educational level were significantly related (P=0.012). High levels of stress and anxiety were accompanied by high levels of depression among participants (P<0.01). CONCLUSIONS The findings from the present study showed that the COVID-19 pandemic has had an effect on depression, anxiety, and stress levels in oncology staff in BiH. Monitoring these levels and providing interventions and support to oncology staff are increasingly important for their wellbeing and retention at a time of global crisis in healthcare.

Association between Resilience and Quality of Life in Patients with Colon Cancer.

INTRODUCTION: Colon cancer is one of the most common malignancies. Numerous studies suggest an association between resilience and quality of life in colon cancer patients. The aim of this study was to explore the association between resilience and quality of life in people with colon cancer. SUBJECTS AND METHODS: A cross-sectional study was conducted on a sample of 200 subjects at the Oncology Clinic of the University Clinical Hospital Mostar. Data were collected in the period between April 2019 and June 2021. A socio-demographic questionnaire specifically designed for this study, a CD-RISC-25 scale for assessing resilience, and a WHOQOL-BREF questionnaire for assessing quality of life were used for collecting data. RESULTS: A statistically significant positive association of resilience with all domains of quality of life was found. The mental health domain contributed the most statistically significantly positively to the level of resilience. Patients who were not married had a statistically significantly higher level of resilience compared to married, divorced and widowed patients. No statistically significant difference was found in resilience levels relative to other socio-demographic factors and cancer stage. Patients treated with a combination of surgery and chemotherapy had a statistically significantly higher level of resilience compared to patients treated with other therapeutic methods. CONCLUSIONS: Higher level of resilience statistically significantly contributes to a higher level of quality of life in people with colon cancer.

The Role of Family Physicians in the Prevention and Early Detection of Cancer in Herzegovina-Neretva and West-Herzegovina Canton.

BACKGROUND: This study aimed to investigate and analyze the role of general practitioners/family physicians (GPs/FPs) in counseling and encouraging early cancer prevention, their perception of value systems towards health and disease (especially malignant diseases), knowledge and experience with the national and local cancer early detection program. SUBJECTS AND METHODS: A cross-sectional observational study included 38 GPs/FPs from nine municipalities in the Hercegovina-Neretva and West Herzegovina canton. Data were collected by using an Individual questionnaire for all GPs/FPs which was prepared according to the Questionnaire for family physicians on implementing the Cancer Control Program, which is used in Croatia. RESULTS: Statistical analysis showed that most GPs/FPs carried out activities on primary cancer prevention (educating patients about smoking, alcohol, diet, physical activity, cancer education, and screening). The majority of respondents stated that it was not profitable to do screening for lung cancer and stomach cancer. Most GPs/FPs (73.7%) recommended mammography to women individually, sporadically, according to individual risk assessment. CONCLUSIONS: The scientific contribution and the results of this work can be applied in practice in local communities. Given its position in the health system, ongoing contact with the population that elected it, and its impact on the local community in which it operates, GP/FP plays an important role in the prevention of disease. Integration of preventive activities into the daily work of the doctor plays the most important role in achieving excellent results. Family medicine is primarily focused on primary and secondary prevention, which is carried out through a continuous approach and long-term management of patients.

Resilience and Quality of Life of Patients with Breast Cancer.

INTRODUCTION: Breast cancer is the most common malignancy in women. Modern research attempts to investigate the relationship between psychoemotional parameters and the length of survival of breast cancer patients. Understanding the factors which affect a higher level of resilience can have important clinical implications and can represent a guiding principle for designing psychological interventions that would accelerate recovery and improve the quality of life of cancer patients. To explore the relationship between resilience and quality of life of women with breast cancer. METHODS: The study was conducted at the Clinic of Oncology of the University Clinical Hospital Mostar, which included 60 subjects. Objective realization was achieved through using the socio-demographic questionnaire purposely made for this research, the quality of life questionnaire WHQOL-BREF and the psychological resilience questionnaire CD-RISC-25. RESULTS: Subjects treated with radiotherapy achieved statistically significantly higher scores on subscales of the quality of life: mental health, social relations, and the environment. No statistically significant correlations were found between the level of resilience and results in the domains of quality of life. CONCLUSION: There is not a statistically significant association between resilience levels and quality of life in patients with breast cancer.

Impact of COVID-19 Pandemic on Mental Health of Medical Students at the University of Mostar.

BACKGROUND: Previous studies have shown that medical students are more prone to depression, more tired, and more prone to emotional exhaustion, depersonalization and burnout syndrome than other students. In terms of mental health, they are a "more vulnerable" than individuals of the same age in the general population. In December 2019 in Wuhan (China) the outbreak of pneumonia caused by the new coronavirus captured worldwide attention. The implementation of strict quarantine measures kept a large number of people in self-isolation which affected all aspects of life. Objective of the study is to determine the direct impact of the COVID-19 pandemic on mental health and quality of life of medical students and the differences in the impact between genders and years of study. SUBJECT AND METHODS: This is a cross-sectional study conducted from May 25 to June 5 2020. It includes medical students who resided in the country affected by the COVID-19 pandemic. Participants completed a modified anonymous online questionnaire that assessed the Impact of Event Scale, indicators of negative mental health impacts, social and family support, and lifestyle changes due to a pandemic. RESULTS: The mean IES score in the participants showed a moderate stressful impact, with the mean IES score of females being significantly higher than that of males (29 vs. 19) with p<0.001. More than half of the participants had an IES score ≥26. With the onset of the pandemic, 71.5% of all medical students reported feeling increased stress from commitments. CONCLUSIONS: the pandemic had stressful impact on the mental health of medical students and it was significantly more stressful for women and students in the preclinical years of study. The COVID-19 pandemic had no impact on social and family support, however a positive impact on the lifestyle of medical students was found.

The Use of Complementary and Alternative Medicine among Cancer Patients Undergoing Conventional Treatment: A Single-Centre Experience.

BACKGROUND: The alternative medicine is increasingly accepted by modern man. People realize that healing based on natural methods is much more affordable and not more aggressive than taking potent drugs of synthetic origin. The aim of this study was to collect data on the use of complementary agents and alternative medicine in cancer patients treated at the Oncology Clinic of the University Clinical Hospital in Mostar. SUBJECTS AND METHODS: We conducted a cross-sectional study that included 100 patients. Data were collected from a questionnaire compiled for this research, which comprised two groups of questions. The first group examined the sociodemographic characteristics of the respondents, and the second the modalities of using Complementary and Alternative Medicine (CAM), and health and conceptual reasons for use. RESULTS: A total of 72 patients (72.0%) had used a CAM during their anticancer treatment. Only 23% of patients had used CAM before the diagnosis of cancer. Among them, 26 (36.1%) previously discussed the topic with their oncologist. CAMs ranged from herbal medicine (58.3%), cannabinoid oil (19.4%) and different vitamins and minerals (22.2%). CAMs were mainly used to improve the health (40.3%). Among patients who used CAM only 25% find it financially demanding, 90.3% of patients were satisfied with effects of CAMs, and 78.1% would recommend it to other cancer patients. CONCLUSION: Our data showed that in our region, many patients used complementary and alternative methods of treatment. These results are very important because they provide information and give a clearer picture of the use of CAM among cancer patients and, accordingly, the right approach of the health practitioners to the patient, leading to optimized cancer therapy and increased safety.

Correlation of Religiousness with the Quality of Life and Psychological Symptoms in Oncology Patients.

INTRODUCTION: Malignant diseases are one of the leading mortalities in the world, causing a range of psychological symptoms and reducing the quality of life in oncology patients. Examine the correlation of religion with the quality of life and psychological symptoms in oncology patients. SUBJECTS AND METHODS: The cross-sectional study included 100 oncology patients in the test group and 80 internal medicine patients in the control group. A sociodemographic questionnaire was specifically designed for this study, the Duke University Religion Index, the Symptom Check List 90, and the WHOQOL-100 quality of life assessment were used to collect the data. RESULTS: The average score in oncology patients was significantly lower on the subscales for physical health (p<0.000), social connections (p<0.002), and intrinsic religiousness (p<0.046) in comparison to internal medicine patients. On the psychological symptoms scale, the average score was higher in oncology patients with the largest difference observed on the psychoticism subscale (p<0.078). CONCLUSION: Oncology patients are statistically less religious and are not satisfied with the quality of life in comparison to internal medicine patients. Psychological symptoms are more pronounced in oncology patients but the difference is not statistically significant. A lower level of religiousness is statistically negatively correlated with a higher severity of psychological symptoms.

Tumour Size Distribution of Invasive Breast Cancer in a One-Year Period: Case Study Herzegovina.

BACKGROUND: To analyse the early stage breast cancer tumour size distribution as an important prognostic factor among the female patients within our local geographic region of Herzegovina. SUBJECTS AND METHODS: This cross-sectional retrospective study included 379 patients who were treated in 2017 at the Oncology Clinic, University Clinical Hospital Mostar. The patients were divided into two groups based on their primary tumour size: early (≤2 cm) and late (>2 cm) stage groups. RESULTS: The number of patients tested for advanced stage tumours surpassing 2 cm was statistically higher (χ2=106,325; p<0.001). 39.32% (N=149) of the patients presented with tumours ≤2 cm (T1) and 52.24% (N=198) of the total number of the patients presented with tumours >2 cm but ≤5 cm in greatest dimension (T2). The patients' knowledge about breast cancer, availability and adherence of mammography did not show any statistically significant difference with regard to tumour size, while the number of patients with smaller tumours who indicated that they underwent regular mammography was statistically significantly higher (χ2=13,629; p<0.003). CONCLUSIONS: Our data shows that in our region, more women with a diagnosis of breast cancer presented with a larger tumor size. Although there was no statistically significant difference with regard to prior knowledge about breast cancer and availability to mammography, this may be due to a small sample size. Our region does not have a screening mammogram program and this data suggests that the implementation of such a program may improve adherence to existing mammography guidelines which might capture tumors at a smaller size and hence an earlier stage.

Optimization of an ex vivo gene transfer to the hamstrings tendons muscle remnants: potential for genetic enhancement of bone healing.

AIM: To assess whether an adenoviral vector carrying the bone morphogenetic protein genes (Ad.BMP-2) can transduce human muscle tissue and direct it toward osteogenic differentiation within one hour. METHODS: This in vitro study, performed at the Department of Molecular Biology, Faculty of Science, Zagreb from 2012 to 2017, used human muscle tissue samples collected during anterior cruciate ligament reconstructions performed in St Catherine Hospital, Zabok. Samples from 28 patients were transduced with adenoviral vector carrying firefly luciferase cDNA (Ad.luc) by using different doses and times of transduction, and with addition of positive ions for transduction enhancement. The optimized protocol was further tested on muscle samples from three new patients, which were transduced with Ad.BMP-2. Released bone morphogenetic protein 2 (BMP-2) levels in osteogenic medium were measured every three days during a period of 21 days. Expression of osteogenic markers was measured at day 14 and 21. After 21 days of cultivation, muscle tissue was immunohistochemically stained for collagen type I detection (COL-I). RESULTS: The new transduction protocol was established using 108 plaque-forming units (P<0.001) as an optimal dose of adenoviral vector and 30 minutes (P<0.001) as an optimal contact time. Positive ions did not enhance transduction. Samples transduced with Ad.BMP-2 according to the optimized protocol showed enhanced expression of osteogenic markers (P<0.050), BMP-2 (P<0.001), and COL I. CONCLUSION: This study confirms that Ad.BMP-2 can transduce human muscle tissue and direct it toward osteogenic differentiation within 30 minutes.

Workplace Stress in the University Clinical Settings: Comparison between the Cardiac Unit snd Emergency Center Medical Staff.

BACKGROUND: Stress at work is a specific type of stress arising from the work environment. Stress of the medical staff has been investigated in recent years by the medical institutions of different countries. The aim of this study was to examine the stress levels in medical staff of Department of Cardiac Surgery and Center of emergency medicine (CEM) in the Clinical settings, and to compare them. SUBJECTS AND METHODS: We conducted a cross-sectional study which included 55 patients between 21 and 50 years of age. The study group consisted of 30 employees from the Department of Cardiac Surgery of Mostar University Clinical Hospital, while the control group comprised 25 employees from the CEM. Research instruments were the Occupational Stress Questionnaire for Hospital Health Care Workers (OSQ-HHCW), General Health Questionnaire (GHQ 28) and a Stress MGMT-TEST A. RESULTS: The subjects from the control group had significantly higher stress experience in "bombing" with new information (p=0.028), unavailability of literature (p=0.039), poor communication with superiors (p<0.001), conflicts with patients (p=0.042) and inappropriate public criticism (p=0.007). The highest stress level showed F1 group of stressors, concerning the organization of work and funding. CEM employees had statistically significantly higher level of stress on public criticism and lawsuits compared to the study group (p=0.013), as well as higher score on the anxiety/insomnia subscale (p<0.001), social dysfunction scale (p=0.002) and on the depression subscale (p<0.001). CONCLUSIONS: Stressors from the group of organizational factors have proven to be the most common stressors in both groups. However, in some areas within the impact of workplace stress, CEM employees had significantly greater vulnerability compared to employees of the Department of cardiac surgery. Further studies are needed to establish the frequency and intensity of stress among health professionals, and to clearly determine the risk factors for its development.

Capacity of muscle derived stem cells and pericytes to promote tendon graft integration and ligamentization following anterior cruciate ligament reconstruction.

PURPOSE: The aim of this study is to examine the capacity of muscle tissue preserved on hamstring tendons forming candy-stripe grafts in order to improve tendon to bone ingrowth and ligamentization. We hypothesized that muscle tissue does possess a stem cell population that could enhance the healing process of the ACL graft when preserved on the tendons. METHODS: Human samples from gracilis and semitendinosus muscles were collected during ACL surgery from ten patients and from these tissue samples human muscle-derived stem cells and tendon-derived stem cells were isolated and propagated. Both stem cell populations were in-vitro differentiated into osteogenic lineage. Alkaline phosphatase activity was determined at days zero and 14 of the osteogenic induction and von Kossa staining to assess mineralization of the cultures. Total RNA was collected from osteoblast cultures and real time quantitative PCR was performed. Western-blot for osteocalcin and collagen type I followed protein isolation. Immunofluorescence double labeling of pericytes in muscle and tendon tissue was performed. RESULTS: Mesenchymal stem cells from muscle and tendon tissue were isolated and expanded in cell culture. More time was needed to grow the tendon derived culture compared to muscle derived culture. Muscle derived stem cells exhibited more alkaline phosphatase actvity compared to tendon derived stem cells, whereas tendon derived stem cells formed more mineralized nodules after 14 days of osteoinduction. Muscle derived stem cells exhibited higher expression levels of bone sialoprotein, and tendon derived stem cells showed higher expression of dental-matrix-protein 1 and osteocalcin. Immunofluorescent staining against pericytes indicated that they are more abundant in muscle tissue. CONCLUSIONS: These results indicate that muscle tissue is a better source of stem cells than tendon tissue. Achievement of this study is proof that there is vast innate capacity of muscle tissue for enhancement of bone-tendon integration and ligamentization of ACL hamstring grafts and consequently muscle tissue should not be treated as waste after harvesting.

Public Health Achievements and Challenges: Symposium of the University of Mostar Faculty of Health Studies.

Public health is an important area of health care that reflects the readiness of the state and society to provide the welfare of all citizens through the promotion of health and the preservation of a healthy environment - factors that directly affect the health of the population. The field of public health is very broad and its concept is changing over time, being defined in a narrower and wider sense. In short, public health is a science and practice that aims at ensuring the conditions in which people can preserve and improve their health and prevent health damage. The third millennium brings its specifics, needs and priorities according to challenges public health is faced by in the twenty-first century: the economic crisis, rising inequality, population aging, rising rates of chronic diseases, migration, urbanization, ecosystem change, climate change, etc. The role of public health is to protect, improve health, prevent diseases and injuries. Such a public health approach implies a multisectoral work focusing on "wider health determinants", and within this activity experts from various medical and non-medical profiles, whose field of public health is concerned, can be found. The development of inter-departmental co-operation skills contributes to a better understanding of health professionals and professionals of other profiles, and facilitates common, synergistic actions in addressing public health problems in the community. Symposium on Public Health Achievements and Challenges organized by the University of Mostar Faculty of Health Studies is just another indication of the obligation, the need and the desire for professional and scientific contribution to the fight for better health. Our faculty has so far organized other numerous symposia, and the aim of this symposium is to present public health achievements and challenges in our surrounding in order to protect, improve health, prevent diseases and injuries in a modern way.

The relationship between health locus of control, depression, and sociodemographic factors and amount of time breast cancer patients wait before seeking diagnosis and treatment.

BACKGROUND: In the Federation of Bosnia and Herzegovina, the prevalence and incidence of breast cancer has been increasing, and the national programme of early prevention, administered locally, is sporadic and without quality assurance. While many factors may influence women's decision to adopt prevention-oriented behaviours regarding breast cancer, this study has emphasised the importance of sociodemographic factors, psychological factors and mental wellbeing. SUBJECTS AND METHODS: Participants in the study were all patients who, during one year, were admitted for the first time for diagnosis and treatment in the biggest Clinical hospitals of the Herzegovina-Neretva region Patients were divided into two groups based on their TNM classification: "early stage" and "late stage". Three instruments were used in this study: an individual questionnaire about demographic and socioeconomic characteristics of the woman, the Multidimensional Health Locus of Control scales, and the Hamilton Depression Rating Scale. RESULTS: The majority of patients diagnosed with advanced disease were admitted to hospital in the late/advanced stages of the disease. Multi-variant analysis showed that the most statistically significant positive predictor for early admittance in hospital is living with family and marital status while religiosity has a negative predictive value. The results indicate that 59.7% of respondents do not have depression, while the remainder do have some degree of depression. There was no statistically significant difference in the degree of depression between women who were diagnosed and treated early and those who were not. The employment status of the respondents was the only significant factor related to degree of depression. CONCLUSION: Although health locus of control and depression are not statistically significant predictors of early hospital treatment, the recommendation is that further studies focus on the implementation of MHLC and HDRS scales within the community. This could be useful in planning appropriate and specific interventions, not only because of early diagnosis, but also to ensure good mental health and resilient behaviour.

Immunohystochemical Expression of Vitamin D Receptor in Development Stages of Colorectal Carcinoma.

BACKGROUND: Chemo preventive and antitumor role of vitamin D is manifested through genetic and non genetic ways with a powerful antproliferatory and proapopoptic effect, which is proven by numerous epidemiologic studies. The genetic activity of vitamin D is determined through vitamin D receptors (VDR), a member of stero-thyreoidal family of nuclear receptors, which with vitamin D form a cell nucleus complex responsible for the chemo preventive and antitumor effect. VDR in tissue cells is present in the cytoplasm and the nucleus and manifests its genetic activity after transfer from the cytoplasm to the nucleus. The mechanisms for the transport and genetic control of the transport of VDR from cytoplasm to the nucleus in not yet completely understood. SUBJECTS AND METHODS: By using immunohystochemistry we are evaluating the correlation of cytoplasmic and nuclear expression of VDR during different stages of colorectal carcinoma: normal colorectal mucosa, hyperplasic polyp, low grade adenoma (LGD), high grade adenoma (HGD) and colorectal cancer. RESULTS: Our results confirm that the nuclear VDR expression is strongest in normal colorectal mucosa and in hyper plastic polyps, is gradually weakened in low and high grade adenoma while it is extremely weak or absent in colorectal carcinoma. At the same time the expression of cytoplasm VDR is weakest in normal colorectal mucosa and hyper plastic polyps while it grows during the adenoma stage and is most expressed during colorectal carcinoma. CONCLUSION: We conclude that vitamin D has a strong chemo preventive and antitumor effect in normal colorectal mucosa and hyper plastic polyps, while its antitumor and chemopreventive effect is progressively weakened and ultimately absent in colorectal carcinoma.

Cytotoxic activity of novel palladium-based compounds on leukemia cell lines.

Effective treatment methods for human leukemia are under development, but so far none of them have been found to be completely satisfactory. It was recently reported that palladium complexes have significant anticancer activity as well as lower toxicity compared with some clinically used chemotherapeutics. The anticancer activities of two novel palladium(II) complexes, [Pd(sac)(terpy)](sac)·4H2O and [PdCl(terpy)](sac)·2H2O, were tested against three human leukemia cell lines, Jurkat, MOLT-4, and THP-1, in comparison with cisplatin and adriamycin. The cytotoxic effect of the drugs was determined using the MTT assay. Cell death was assessed using fluorescein isothiocyanate-annexin/propidium iodide staining for flow cytometry. Furthermore, p53 phosphorylation, poly(ADP-ribose) polymerase cleavage, and Bax and Bcl-2 mRNA levels were examined to elucidate the mechanism of cell death induction. Both complexes exhibited a significant dose-dependent antigrowth effect in vitro. The complexes predominately induced apoptosis, but necrosis was also observed. In-vitro results have shown that palladium(II) complexes may be regarded as potential anticancer agents for treating human leukemia. Therefore, further analysis to determine the putative mechanism of action and in-vivo studies on animal models are warranted.

The Influence of Serum Cortisol Level Onto Perceptive Experience of Optimism in Patients with Newly Diagnosed Cancer.

THE AIM: The aim of this study is to investigate the correlation between the morning level of serum cortisol and perceptive experience of optimism in a selected group of 60 patients with newly diagnosed cancer who were treated at Mostar University Clinical Hospital during a one-month period. PATIENTS AND METHODS: The morning level of serum cortisol was measured in all patients following the verification of oncological disease. The patients also filled out a questionnaire of socio-demographic data, as well as the scales for optimism/pessimism assessment. RESULTS: The average morning serum cortisol level was within the reference values in the majority of patients, independently of their perceptive experience of optimism/pessimism. There was no significant difference in the morning level of serum cortisol among the subgroups of patients high and low on the scale of optimism, as well as the scale of pessimism. No correlation existed between the serum cortisol morning level and expressed optimism/pessimism, as well. The great majority of respondents had secondary and lower education, was retired or unemployed, and suffered lower socio-economic conditions of life. Therefore, their access to medical information and their knowledge of cancer modern treatment options and possibilities were restricted, what may also have an influence onto perceptive experience of optimism/pessimism. CONCLUSION: The results concerned with the perceptive experience of optimism/pessimism assessment were not a consequence of stress reaction but they were more correlated to general personal characteristics, the level of education, and socio-economic status of patients. The results do not confirm the impact of morning serum cortisol level onto physiological reactions to stressful conditions and situations in selected group of patients with de novo carcinoma.

Risk behaviour of prison inmates in relation to HIV/STI.

INTRODUCTION: Persons serving a prison sentence are identified as a population exposed to a higher risk of HIV/STIs due to a high incidence of risk behaviour, especially intravenous drug misuse. To show results of research on prevalence of HIV/STIs in relation to spread of risk behaviour and other risk factors. SUBJECTS AND METHODS: Cross-sectional study on a sample of 620 respondents in 10 prisons. A specially structured questionnaire was applied as a research instrument, together with blood sample taking for laboratory analysis of HIV, HBV, HCV and syphilis. RESULTS: Majority of respondents show insufficient knowledge about HIV/AIDS, ways of transmission prevention, especially knowledge on ways of HIV transmission. Every sixth respondent has experience of intravenous drug use, of which 58% exchanged drug injection equipment. Every fifth respondent with a tattoo had their tattoo done in prison. Below 2% of respondents quote being victims of sexual abuse, and having wilful anal sexual intercourse in prison. Test results in this research: HIV (0), HBV (1.5%), HCV (14.3%) syphilis (0.5%). CONCLUSION: Intravenous drug use presents the strongest risk factor for HCV, and therefore for HIV/ STIs. Other risk factors - tattooing with kit exchange, sexual risk intercourse, abuse, insufficient knowledge and information about HIV/AIDS, ways of transmission and way of protection, and lack of access to measures of prevention and "Harm reduction" programme.

Co-administration of pazopanib and enteral nutrition with omega-3 fatty acids as a safety issue in a patient treated for metastatic clear cell renal cancer: A case report.

Pazopanib is an oral multitargeting tyrosine kinase inhibitor (TKI) of vascular endothelial growth factor receptors (VEGFRs), approved as the first-line treatment of metastatic renal cell carcinoma (mRCC) and soft tissue sarcoma (STS) at a fixed dose of 800 mg daily taken fasted. Potential drug-meal interactions and adverse events (AEs) may lack recognition and the related data in literature. We report one case of stomatitis/oral mucositis associated with pazopanib administrated with an oral nutritional supplement enriched with omega-3 fatty acids. The 50-year-old patient with mRCC started pazopanib treatment at standard doses of 800 mg daily as first-line therapy for mRCC, and after a few days, he developed stomatitis. Co-administration of pazopanib with high-fat meals could increase the solubility of highly lipophilic pazopanib, increasing its plasma pazopanib area under the curve (AUC), and maximum concentration (Cmax) above optimal therapeutic level can consequently lead to increased frequency/grade of AEs.