The current study aimed to explore whether the level of decrease in platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and mean platelet volume (MPV) has prognostic value for major adverse cardiovascular events (MACEs) in acute myocardial infarction without ST-segment elevation (NSTEMI) treated with clopidogrel. In this prospective observational cohort study, PDW, P-LCR, and MPV were determined on admission at the hospital and 24 h after clopidogrel treatment in 170 non-STEMI patients. MACEs were assessed over a one-year follow-up period. Using the Cox regression test, a decrease in PDW showed a significant association with the incidence of MACEs (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.66–0.99, p = 0.049) and overall survival rate (OR 0.95, 95% CI = 0.91–0.99, p = 0.016). Patients with a decrease in PDW<9.9% had a higher incidence of MACEs (OR 0.42, 95% CI = 0.24–0.72, p = 0.002) and a lower survival rate (OR 0.32, 95% CI = 0.12–0.90, p = 0.03) than patients who had a decrease in PDW < 9.9%. In the Kaplan–Meier analysis using log-rank test, patients who had a decrease in PDW < 9.9% had an increased risk for MACEs (p = 0.002) and lethal outcomes (p = 0.002). However, a decrease in MPV or P-LCR did not have prognostic value. A decrease in PDW < 9.9% measured 24 h after clopidogrel treatment in NSTEMI patients has good prognostic value for determining the short-term risks of MACEs, possibly providing a better risk stratification of those patients.

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS), characterized by neurodegeneration, axonal damage, demyelination, and inflammation. Recently, gut dysbiosis has been linked to MS and other autoimmune conditions. Namely, gut microbiota has a vital role in regulating immune function by influencing immune cell development, cytokine production, and intestinal barrier integrity. While balanced microbiota fosters immune tolerance, dysbiosis disrupts immune regulation, damages intestinal permeability, and heightens the risk of autoimmune diseases. The critical factor in shaping the gut microbiota and modulating immune response is diet. Research shows that high-fat diets rich in saturated fats are associated with disease progression. Conversely, diets rich in fruits, yogurt, and legumes may lower the risk of MS onset and progression. Specific dietary interventions, such as the Mediterranean diet (MD) and ketogenic diet, have shown potential to reduce inflammation, support neuroprotection, and promote CNS repair. Probiotics, by restoring microbial balance, may also help mitigate immune dysfunction noted in MS. Personalized dietary strategies targeting the gut microbiota hold promise for managing MS by modulating immune responses and slowing disease progression. Optimizing nutrient intake and adopting anti-inflammatory diets could improve disease control and quality of life. Understanding gut-immune interactions is essential for developing tailored nutritional therapies for MS patients.

Background Non-ST-elevation myocardial infarction (NSTEMI) represents a prevalent form of acute coronary syndrome associated with substantial early risk of adverse outcomes. Inflammatory and metabolic disturbances are increasingly recognized as key contributors to the disease. Hematologic indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV), along with the triglyceride-glucose index adjusted for BMI (TyG-BMI), have emerged as promising prognostic markers. However, their dynamic behavior in early NSTEMI remains insufficiently explored. Materials and methods This prospective study included 170 patients hospitalized for NSTEMI at the University Clinical Centre Tuzla between February 2022 and January 2023. Hematologic and metabolic indices were calculated at admission and repeated 24 hours later. Patients were followed for three months to document major adverse cardiovascular events (MACE), including cardiovascular death, reinfarction, and urgent revascularization. The median age was 67 years, and 60.6% of patients were male. Hypertension, hyperlipidemia, and diabetes mellitus were the most common comorbidities. Results Significant 24-hour reductions were observed in NLR, PLR, SII, SIRI, and PIV (all p < 0.01), while C-reactive protein (CRP) levels more than doubled (p < 0.001). Patients who developed MACE showed persistently elevated inflammatory indices and smaller declines in PIV and SIRI. Change in SIRI (ΔSIRI) demonstrated the strongest predictive value (AUC = 0.63), followed by SII and TyG-BMI. Notably, reduced resolution of PIV and persistently elevated TyG-BMI were significantly associated with adverse outcomes. Overall, MACE occurred in 51.2% of patients, including a 14.7% mortality rate. Conclusion Early changes in systemic inflammation and metabolic stress, particularly SIRI and TyG-BMI dynamics, offer valuable prognostic insight and may enhance early risk stratification in NSTEMI patients.

Background Heart failure (HF) is characterized by impaired cardiac function. Based on left ventricular ejection fraction (LVEF), it is classified into HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF). Each phenotype has distinct pathophysiological mechanisms and clinical features. Recent findings indicate that systemic inflammation is a significant factor in the progression of heart failure. Inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and lymphocyte-to-monocyte ratio (LMR), may serve as valuable tools for evaluating the inflammatory response in heart failure. Materials and methods This prospective observational study, which included 171 HF patients, was conducted from February 2022 to January 2023 at the Intensive Care Unit, University Clinical Centre Tuzla. Based on LVEF, patients were categorized into HFrEF, HFmrEF, and a control group (HFpEF). The study aimed to assess the prognostic value of NLR, MLR, and LMR in predicting major adverse cardiovascular events (MACE) and mortality over a 12-month follow-up period. Results NLR and MLR were significantly higher, while LMR was lower in both HFrEF and HFmrEF compared to controls, indicating a strong inflammatory response, particularly in HFrEF. NLR demonstrated a strong ability to distinguish between HF phenotypes. HFmrEF's markedly higher high-sensitivity troponin I (hsTroponin I) level suggested higher cardiac stress. MACE rates were similar across groups; mortality was significantly higher in HFrEF. Conclusion Inflammatory biomarkers NLR, MLR, LMR, and hsTroponin I could be crucial in assessing heart failure, particularly in patients with HFrEF and HFmrEF.

Aim This study compared the extent of coronary artery calcification in patients with and without type 2 diabetes mellitus (T2DM) using Coronary Computed Tomography Angiography (CCTA). Methods This retrospective, observational cohort study included 107 patients who underwent CCTA at the Clinical Centre of the University of Sarajevo between July and December 2024. Patients were divided into two groups: those with T2DM (n=51) and those without T2DM (n=56). Laboratory parameters, demographic data, and calcium scores were analysed. The calcium score was categorised into six groups based on cardiovascular risk and the comparison was made using appropriate statistical analysis. Results Patients with T2DM had significantly higher calcium scores than non-diabetic patients (p=0.0001). In the T2DM group, 35.3% of patients had a calcium score >400, indicating high cardiovascular risk. Patients without diabetes were more frequently classified into lower-risk categories (p=0.0001). A significant correlation was found between calcium score and age (r=0.442, p=0.001) and gender (r=-0.218, p=0.024), with men having higher calcium scores. Additionally, total cholesterol, LDL, and uric acid levels were significantly higher in diabetic patients (p=0.005; p=0.025; p=0.03, respectively). Conclusion This study confirms a strong association between T2DM and increased coronary artery calcification. Age and male gender are significant predictors of higher calcium scores. Further research is needed to explore these relationships, particularly within the Bosnian population. Keywords Coronary angiography, coronary artery calcification, coronary disease, diabetes mellitus type 2

Background Acute cholecystitis (AC) is a frequent surgical emergency associated with significant variability in clinical outcomes and hospital length of stay (LOS). Early identification of patients at risk for prolonged hospitalization can improve triage and resource planning. Inflammatory markers such as C-reactive protein (CRP), white blood cell count (WBC), and total bilirubin (TBil), along with biliary complications like choledocholithiasis and Mirizzi syndrome, may have prognostic value. Materials and methods This retrospective study included 150 patients who underwent cholecystectomy for AC at the Department of General and Abdominal Surgery, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina, between January 1, 2024, and January 31, 2025. Demographic, laboratory, and intraoperative data were collected. Receiver operating characteristic (ROC) analysis identified optimal cut-offs for inflammatory markers predicting prolonged LOS (≥7 days). Multivariate linear regression was used to assess independent predictors, including CRP, WBC, TBil, and intraoperative findings. Results We found that CRP was significantly higher in patients with prolonged LOS and demonstrated the highest predictive accuracy, with an area under the curve (AUC) of 0.733 (95% CI: 0.630-0.835), followed by TBil and WBC. In multivariate analysis, only CRP ≥110.5 mg/L (p<0.001), the presence of choledocholithiasis in 26 patients (17.3%; p=0.010), and Mirizzi syndrome in seven patients (4.7%; p=0.017) remained significant predictors. WBC and TBil lost significance after adjustment. Conclusion CRP is the most reliable independent laboratory predictor of prolonged LOS in AC. The presence of choledocholithiasis and Mirizzi syndrome further contributes to extended hospitalization. These factors should be considered in early clinical risk assessment.