INTRODUCTION:Traditional diagnostics rely on microscopy, dipstick tests, and the gold‑standard urine culture, which is reliable but time‑consuming. Flow cytometry for urinary analysis offers a fast, objective, and highly automated approach that can improve the selection of samples for culture and accelerate clinical decision‑making. Flow cytometry uses fluorescent and scatter detection to quantify cells, bacteria, and other particles in urine, processing thousands of events per sample and generating parameters that correlate with the presence of infection. METHODS:This retrospective study included 200 hospitalized adult patients (>18 years) admitted to the Clinic for Infectious Diseases, University Clinical Center Tuzla in Tuzla, Bosnia and Herzegovina. A urinary tract infection (UTI) was diagnosed based on standardized clinical and laboratory criteria. Urine samples were analyzed using the Sysmex UF‑4000 flow cytometer, and diagnostic thresholds for leukocyte and bacterial counts were determined by receiver operating characteristic (ROC) analysis and Youden's Index. RESULTS:Among 200 hospitalized patients, females predominated (124 vs. 76). Optimal cut-offs were ≥120/µL for leukocytes (area under the curve (AUC) 0.88, sensitivity 91.2%, specificity 75.3%) and ≥1367/µL for bacteria (AUC 0.95, sensitivity 90.3%, specificity 90.7%). Sex-specific analyses showed higher accuracy in males, with cut-offs of ≥1012/µL for bacteria (AUC 0.97) and ≥122/µL for leukocytes (AUC 0.94), while in females, the best thresholds were ≥1797/µL for bacteria (AUC 0.94) and ≥113/µL for leukocytes (AUC 0.84). The empirically developed UTI risk score (0-2) further improved stratification: Score 0 strongly predicted negative cultures (NPV >97%), while Score 2 was highly associated with positive cultures (PPV >94%). CONCLUSIONS:Automated urine flow cytometry offers a fast and accurate screening tool for UTIs, with bacterial counts outperforming leukocytes in diagnostic reliability. Sex-specific cut-offs and the UTI risk score enhance clinical applicability by improving stratification and reducing unnecessary cultures. While findings support integration of flow cytometry into routine practice, the single-center design, hospitalized cohort, and exclusion of pregnant women and children limit broader generalization, warranting validation in larger, multicenter studies.
Newborn screening (NBS) is a well-established public health program that enables early detection and treatment of rare disorders in newborns, preventing severe complications or death. Despite its recognized importance, the scope and implementation of NBS programs vary across Southeastern (SE) and Central Europe. This study aimed to evaluate the current status of NBS in 16 countries of SE and Central Europe and assess progress since the previous survey in 2021. A structured questionnaire was distributed to national experts between April and December 2025, collecting data on program organization, coverage, diseases included, laboratory methods, confirmatory testing, consent practices, and future expansion plans. All countries reported universal screening for congenital hypothyroidism, except Kosovo, where a national NBS is in the process of being established. Expanded NBS using tandem mass spectrometry was available in Austria, Bulgaria, Croatia, Cyprus, Greece, Hungary, North Macedonia, Romania, and Slovenia. Spinal muscular atrophy screening became universal in Austria, Croatia, Hungary, Serbia, and Slovenia. Most countries reported plans for further expansion, with congenital adrenal hyperplasia, severe combined immunodeficiency, spinal muscular atrophy, and cystic fibrosis being the most frequently targeted conditions. Although notable infrastructural progress has been achieved, financial constraints, lack of staff, and organizational barriers remain key challenges. The study’s assessment of program effectiveness was further limited by the absence of region-wide systems for capturing end-to-end performance indicators, such as the age of the infant at treatment initiation or missed cases. Regional collaboration and adoption of best practices are therefore vital to ensure equitable access and continuous advancement of NBS programs.
Chimeric Antigen Receptors (CAR) T-cell therapy is a ground-breaking discovery in immunotherapy, mainly known for its exceptional results in treating haematological malignancies. The latest research has revealed that the potential of CAR T-cell therapy extends far beyond its current capabilities and could represent a novel therapeutic approach for treating various cancers. This review aims to summarize the latest innovations in CAR T-cell therapy applied in cancer treatment, including multiple myeloma, osteosarcoma, glioblastoma, melanoma and various childhood malignancies. However, several challenges limit success of CAR T-cell therapy, including the antigen escape phenomenon, 'on-target off-tumour' toxicity, penetration into solid tumour tissue, alongside the cost-effectiveness concerns. The improvement of cancer immunotherapies currently available requires an increase in the effectiveness of CAR T-cells in managing refractory and solid cancers. This could be achieved by using CAR T-cells to target various antigens, enhancing their local delivery and tumour infiltration capabilities and utilizing CAR T-cells in combination with checkpoint blockade and immunotherapy, such as PD-1 blockade and CD19 CAR T-cell combined therapy. Although CAR T-cell treatment offers a lot of promise, its cost needs to be taken into account, especially in healthcare systems with limited funding. More importantly, frameworks for Health Technology Assessment (HTA) must adapt to incorporate ethical, sociological and psychological aspects. Reducing CAR T-cell toxicity is also essential, as it remains among biggest obstacles to their widespread application in clinical practice. Future research should therefore focus on enhancing our understanding of CAR T-cell therapy and expanding the application of immunotherapy in treatment.
OBJECTIVE:To evaluate perineal length and thickness during labor and to assess their association with any spontaneous perineal tear. STUDY DESIGN:This prospective study included 221 women with term singleton pregnancies and cephalic presentation. Perineal length and thickness were measured in early labor (≤4 cm cervical dilatation) and reassessed in the second stage (full dilatation). The primary outcome was any spontaneous perineal tear, including grades I-IV. Multivariable logistic regression analysis was performed to assess these associations, adjusting for parity, body mass index and birth weight. RESULTS:Spontaneous perineal tears occurred in 31 women (14.0%). In multivariable analysis, shorter perineal length in the first stage of labor was independently associated with higher odds of spontaneous tear (OR 0.42; 95% CI 0.20-0.86; p = 0.018). In the second-stage model, greater perineal thickness was independently associated with higher odds of spontaneous tear (OR 2.34; 95% CI 1.08-5.05; p = 0.031). BMI, parity, and neonatal birth weight were not independently associated with the outcome. In sensitivity analyses with additional adjustment for episiotomy, perineal morphometric characteristics were no longer statistically significant. CONCLUSION:Shorter perineal length in early labor and greater perineal thickness at full dilatation were associated with any spontaneous perineal tear in primary multivariable analyses. However, after additional adjustment for episiotomy in sensitivity analyses, these associations were no longer statistically significant. These findings suggest an association between perineal morphometry and spontaneous perineal tears, but do not support using perineal measurements as standalone markers.
BackgroundLarge language models (LLMs) are increasingly being studied as potentially valuable support tools in oncology practice including clinical decision support. Yet, their real-world utility in melanoma treatment decision-making is still not sufficiently considered, especially in resource-limited settings. Accordingly, this study evaluated the performance of four LLMs against real-world treatment decisions of a melanoma multidisciplinary tumor board (MDT).MethodsThis retrospective single-center study included 151 consecutive patients with newly diagnosed cutaneous melanoma discussed at the MDT at the University Clinical Center Tuzla, Bosnia and Herzegovina, between 2020 and 2024. Melanoma treatment recommendations generated by four LLMs, ChatGPT-4o, ChatGPT-5 Thinking, Gemini 2.5 Pro and DeepSeek-V3.2, were evaluated by four board-certified oncologists against the actual MDT treatment decisions. Additionally, the LLM-generated recommendations were also rated across five pre-specified domains: clarity, clinical applicability, coverage, explanation and support with evidence, and guideline concordance.ResultsIn this study, inter-rater reliability was acceptable to good, supporting the consistency of expert evaluation. ChatGPT-5 Thinking showed the strongest and most consistent overall performance, followed by ChatGPT-4o, while Gemini 2.5 Pro and DeepSeek-V3.2 were rated less favorably. Differences between LLMs were statistically significant across all evaluated domains. Performance differences appeared most clinically relevant in more complex scenarios, particularly when consideration of adjuvant or systemic treatment strategies was required.ConclusionThe findings of this study suggest that selected LLMs may have a supportive role in everyday melanoma MDT practice particularly in oncology centers with limited resources. However, the current results do not support the use of LLM-generated recommendations as independent treatment decisions, and further prospective studies are required before LLM-assisted treatment recommendations can be safely integrated into the MDT workflow.
