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/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.

BackgroundThe purpose of this study is to establish whether the lymph node metastases of the papillary thyroid carcinoma are a significant factor in recurrence of the disease by analyzing the time until recurrence of the disease and frequency of recurrence of the disease.MethodsFrom 1 January 1995 until 30 June 2017, 102 patients were treated at the Public Health Institute Hospital “Sveti Vracevi” in Bijeljina for PTC. In all patients, surgery of the thyroid gland and/or lymph nodes of the neck was performed. Total thyroidectomy (TT) was performed in 20 patients and near-total thyroidectomy leaving <1 g thyroid tissue adjacent to the recurrent laryngeal nerve in 7 patients. TT and lymph nodes dissection were performed in 71 patients. Palliative surgery and biopsy due to locally advanced disease were performed in 3 patients.ResultsIn our study, 102 patients with PTC were analyzed. 82 patients experienced pure PTC (80.4%), the other 20 patients (19.6%) experienced other variants of PTC. 24 patients (23.5%) experienced multi centric or bilateral tumors. 71 patients (69.6%) experienced histologically verified metastases in the lymph nodes of the neck. 7 patients (6.8%) experienced distant metastases. 20 patients underwent total thyroidectomy (TT), and 7 near-total thyroidectomy. Total thyroidectomy + dissection of central and lower jugular lymph nodes with frozen section histopathology verification was performed in 71 patients (69.6%). Out of these 71 patients, in 50 patients (70.4%) metastases were verified in the lower jugular lymph nodes. A modified lymph node dissection (MRND) was also performed in these patients.ConclusionLymph node metastases of the papillary thyroid carcinoma are a plausible prognostic factor. They are important for recurrence of the disease, but not for survival.

Malignancy is one of the major public health problems in Bosnia and Herzegovina. Along with breakthroughs in specific oncological therapy, improving the quality of life of cancer patients and management of therapy-induced side effects need to be recognized as a priority in the comprehensive cancer patient care. Fertility loss after cancer treatment is a field requiring special attention due to its various consequences on patients themselves.  Although oncofertility is well-recognized area of oncology, low- to middle-income countries are facing issues with its implementation in everyday practice. Increased awareness about fertility preservation is of high priority for all specialists who participate in the medical care of cancer patients. The absence of a systemic solution and lack of expertise led to the founding of Fertility Preservation Working Group of the Oncology Association of Bosnia and Herzegovina. We have made recommendationsas an expert consensus with the ultimate goal of making the first step towards enhancement of oncofertility implementation in Bosnia and Herzegovina.

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Introduction: Sentinel lymph node biopsy is a standard staging procedure in patients with early breast cancer. Aim of the study is a validation procedure of sentinel lymph node biopsy (SLNB) in our institution and comparison between two mapping techniques-isotope mapping and methylene blue dye for lymphatic mapping. Material and methods: The study comprised 75 women with breast cancer of clinical stage T1-2N0M0. We analyzed patients from June, 2010 to March, 2013. In 39 patients, (Group A) lymphatic mapping technique was performed by using the peritumoral injection of 37MBq activity isotope (99m Technetium NANOCIS),and in 36 patients (Group B) mapping technique was performed by using the periareolar injection of 2-4 ml blue dye (Methylene blue 1%). Axillary dissection was performed in both groups after SLNB. Results: Out of 75 patients, sentinel lymph node was identified in 68 (90.7%). Identification rate was similar between the groups-89.7% (Group A), 91.7% (Group B). Accuracy rate was 97% between the groups, that is, Group A 97.1% and Group B 96.9%. In relation to the Group A (90.6%), sensitivity rate was slightly higher in the Group B-91.6%,. False negative rate of SLNB was higher in the Group A (9.1%) in relation to the Group B (8.3%). The average number of sentinel nodes detected in both groups was 1.2. Conclusion: The results of the study confirmed and validated both methods of lymphatic mapping techniques in SLNB. There were no significant statistical differences (p>0.05) in accuracy, sensitivity and false negative rate between these two groups.

Receptor humanog epidermalnog faktora rasta 2 – HER2 (c-erb-B2) je prisutankod 15-20% karcinoma dojke u trenutku postavljanja dijagnoze. Prekomjernaekspresija HER2 receptora povezana je sa agresivnijom formomkarcinoma dojke. Trastuzumab je humano monoklonsko antitijelo kojevezujući se za HER2 receptor blokira signalne puteve ćelijske proliferacije.S obzirom na moguću pojavu rezistenzije na trastuzumab (vezuje se zapoddomenuII HER2 receptora te ostvaruje ligand nezavisnu inhibiciju ćelijskeproliferacije), tokom godina kreirano je drugo monoklonsko antitijelopertuzumab (vezuje se poddomenu IV HER 2 receptora i ostvaruje ligandzavisnu inhibiciju ćelijske proliferacije) te zajedno čine temelj dualne blokadeHER2 receptora. Brojne studije su pokazale korist od primjene trastuzumabai pertuzumaba, prvobitno u metastatskom, a potom i u adjuvantnomi neoadjuvantnom režimu. Neoadjuvantna (preoperativna) terapijase ordinira kod inoperabilnih tumora, kod bolesnika sa visokim rizikom odlošeg ishoda (HER2 pozitivni tumori, nodus pozitivni tumori, inflamatornikracinom dojke, veliki tumori), kao i kad postoje dodatni faktori rizika - HRnegativni tumori kod kojih se ne očekuje korist od hormonalne terapije uadjuvantnom miljeu. Neoadjuvantna terapija, takođe, omogućava in vivouvid u odgovor tumora na neoadjuvantnu terapiju. Kompletan patološkiodgovor (pCR – pathological complete response) je rani parametar efikasnostineoadjuvantnog tretmana koji takođe omogućava da se “na vrijeme”sazna senzitivost tumora i donese odluku o adjuvantnom tretmanu. pCRima prediktivnu i prognostičku vrijednost. Naime, stopa pCR u korelaciji jesa vremenom do progresije bolesti i ukupnim preživljenjem. Brojne studijesu na osnovu stope pCR pokazale da postoje podgrupe HER2 pozitivnihkarcinoma dojke: podgrupa hormon negativnih tumora koji imaju dobarodgovor na postojeću antiHER2 terapiju i HER2 pozitivni karcinomi dojke,podgrupa hormon zavisnih tumora, kod kojih se postojećim terapijskim opcijamajoš uvijek ne postiže adekvatna stopa pCR što predstavlja područjeza nova istraživanja i pronalaženje novih strategija liječenja.

Kratak sadržajUvod. Učestalost karcinoma kolona i rektuma je u postupnom porastu posljednjih dvadeset godina. Da bi procjena ljekara o trajanju života pacijenata i/ili liječenju bila što preciznija, u onkologiji se koriste faktori prognoze i predikcije. Oni se mogu klasifikovati na: kliničko-hirurške, patološko-histološke i imunohistohemijske. Cilj rada je bio utvrditi značaj imunohistohemijskih markera -karcinoembrionalnog antigena (CEA), p53, Ki-67 i proliferišućeg nuklearnog antigena (PCNA) u predikciji preživljavanja pacijenata sa karcinomom kolona i rektuma.Metode. Od 1. januara 2010. godine do 1. decembra 2017. godine u Javnoj zdravstvenoj ustanovi bolnici "Sveti Vračevi" u Bijeljini liječeno je 484 pacijenata sa karcinomima kolona i rektuma kojima je u tkivu karcinoma imunohistohemijskom analizom ispitana ekspresija CEA, p53, Ki-67 i PCNA.Rezultati. Imunohistohemijska analiza tkiva primarnog kolorektalnog adenokarcinoma ispitivanih pacijenata pokazala je jako pozitivnu ekspresiju CEA kod 301 (62%) pacijenta, p53 kod 329 (68%), PCNA kod 314 i Ki-67 kod 275 (56,8%) pacijenata. Pacijenti sa jako pozitivnom ekspresijom CEA, p53 i PCNA su imali statistički značajno lošije preživljavanje u odnosu na pacijente sa slabom ekspresijom ovih imunohistohemijskih markera. Nema statistički značajne razlike u preživljavanju pacijenata sa jako pozitivnim imunohistohemijskim skorom Ki-67 u odnosu na pacijente sa slabo pozitivnim vrijednostima skora.Zaključak. Imunohistohemijska analiza se ne koristi u rutinskoj analizi karcinoma kolona i rektuma, iako imunohistohemijski markeri predstavljaju korisne prediktore preživljavanja pacijenata.Ključne riječi: imunohistohemijski markeri, CEA, p53, Ki-67, PCNA, kolorektalni karcinom, preživljavanje

The HERe2cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards from healthcare institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held in order to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization and optimization of the procedures for the diagnosis, treatment and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a multidisciplinary tumor board comprised of at least: a medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.