Search

Introduction: Benzodiazepines (BZD) are efficient drugs used to reduce anxiety, treat insomnia, or used as myorelaxants. BZDs are generally recommended for short-term use due to numerous side-effects and addiction. Objective: To investigate the prescribing pattern in family medicine outpatient clinics, in patients without the diagnosis of a mental disorder, and the influence of sociodemographic characteristics on BZD use. Method: A retrospective study of BZDs use, in a tenyear period (2009-2019), was conducted in patients treated in five family medicine teams of three primary health care centers in the Republic of Srpska. The study was carried out by reviewing electronic health records (EHRs) of patients above 18 years of age. The patients with the diagnosis of mental disorders were not recruited in the study. The study included 8560 EHRs, and 259 patients with the diagnosis of the mental disorders were excluded from the study. Results: Out of a total of 8301 analyzed EHRs, in 1044 (12.58%) patients at least one prescription for BZDs was found in a ten-year period. Females used BZDs in a greater percentage (71.07%), persons older than 65 years (44.54%), patients with secondary school education (60.44%), patients with chronic diseases (88.60%), patients living in an urban environment (75.96%). The most prescribed BZD was bromazepam (80.17%). Conclusion: The use of BZDs in our patients is quite considerable when compared to recommendations. The strategies to reduce BZD prescribing are necessary to reduce the chronic use of these drugs.

Objective. The aim of our study was to investigate the predictors of morbidity (age, gender, smoking habits, obesity and the presence of chronic diseases) and COVID-19 outcomes.Subjects and Methods. The research was an observational descriptive study, conducted at The Family Medicine Education Center, The Primary Health Care Center, Banja Luka, in the period from 26th June to 31st December 2020. During the research period, seven family medicine teams followed their patients with COVID-19, and recorded possible predictors for morbidity and their influence on the disease outcome.Results. The study included 934 patients, 46.90% of whom were male. The majority of subjects were non-smokers and overweight. Diabetes was found in 5.57% patients, hypertension in 29.44%, chronic respiratory diseases in 5.25%, cancer in 4.39% patients. In the observed sample, 29.23% subjects contracted pneumonia, 18.52% were hospitalized, while 19 (2.03%) patients with severe clinical features had a fatal outcome. Multivariable regression analysis showed a high risk of pneumonia in male patients [OR=2.45, 95% CI (1.73-3.46)], elderly [OR= 1.07, 95% CI (1.06-1.09)] and obese patients with Body Mass Index ≥30.0 kg/m2 [OR=2.55, 95% CI (1.73-3.77)]. Male gender [OR=2.19, 95% CI (1.11-4.31)], older age [OR=1.08, 95% CI (1.05-1.11)] and hypertension [OR=2.51, 95% CI (1.06-5.91)] were the most important predictors for the development of severe clinical features in COVID 19. The statistically significant predictors of mortality were male gender [OR=7.16, 95% CI (1.56-32.86)] and older age [OR=1.12, 95% CI (1.06-1.18]. Conclusion. Being familiar with the predictors of morbidity and poor outcome in COVID-19 is helpful for carrying out preventive measures, early diagnosis and treatment of risk groups of patients.

Introduction. The number of people over 65 is increasing in the world, and falls are rather common among them. The objective of this research was to examine the impact of depression, dementia, the number of chronic diseases and the number of used medications in the risk of falls in the elderly. Material and Methods. We carried out a prospective study during the period from March 20 to May 20, 2016. The patients were interviewed, and data were also obtained from medical records. The data collection included a socio-demographic questionnaire, the Tinetti Gait and Balance Instrument, Beck Depression Inventory and the Folstein Mini-Mental State test to assess cognitive functions. Results. The study included 208 patients older than 65 years, 81 men, 127 women. The Tinetti Gait and Balance tool revealed that onethird (63) of patients were at a high risk of falls, 35 patients at a moderate risk, and 110 patients presented with a low risk of falls. The results of our study showed a statistically significant association between dementia (p = 0.000) and depression (p = 0.000) as the risks of falling. Patients with some chronic diseases and patients continuously taking various drugs were also at higher risk of falls. Conclusion. Timely detection and treatment of depression and dementia may contribute to reducing the risk of falls in the elderly. Patients´ medication lists should be reviewed to decrease the number of medications or modify the dose. Family physicians play a major role in preventing falls in the elderly.

Aim To examine the prevalence of undiagnosed depression among primary care elderly patients in the entity of the Republic of Srpska (Bosnia and Herzegovina) as well as the sociodemographic and clinical risk factors associated with depression. Methods A cross-sectional study was conducted between April and June 2019 in nine towns of the Republic of Srpska. The study sample included 1,198 primary care patients older than 65 years of age. Research instruments included a sociodemographic questionnaire and Geriatric Depression Scale - Short Form (GDS-SF). Results Positive screening test (GDS-SF score5), which indicates depression was found in 484 (40.4%) participants. Multivariate regression analysis showed that lower education levels [OR = 1.565, 95% CI (1.13-2.17)], divorced and widowed [OR = 1.366, 95% CI (1.16-1.62)], poor financial situation [OR = 1.690 , 95% CI (1.25-2.29)], non-home residents [OR = 2.200, 95% CI (1.41- 3.44)], non-hobby patients [OR = 2.115, 95% CI (1.54-2.91) ], non-friends [OR = 3.881, 95% CI (2.70-5.57)], patients suffering from chronic pain [OR = 2.414, 95% CI (1.72-3.39)], patients with daily life limitation activities [OR = 1.415, 95% CI (1.03-1.95)], patients with three or more chronic diseases [OR = 1.593, 95% CI (1.12-2.27)], patients using five or more drugs [OR = 1.425. 95% CI (1.00-2.03)], and patients with history of previous depression [OR = 2.858, 95% CI (1.94-4.21)] were at higher risk for depression. Conclusion The prevalence of undiagnosed depression in the elderly in Republic of Srpska is high. Future strategies are needed to strengthen screening of geriatric depression in primary health care.

Background/Aim. The most sensitive indicators for detecting recurrence of well-differentiated thyroid cancer (DTC) are 131I whole body scintigraphy (WBS) and measurement of serum thyroglobulin (Tg). In order to perform it, it is necessary to raise the level of endogenous tiroidstimulating hormon (TSH), which can be achieved by Lthyroxine withdrawal for 3-5 weeks or administration of recombinant human thyrotropin (rhTSH) without requiring the discontinuation of thyroid hormone therapy. The aim of this study was to assess the effect of rhTSH using in comparison to the traditional thyroid hormone withdrawal in the follow-up of patients with DTC. Methods. This retrospective study included 44 patients, mean age 48.8 years, with DTC divided into 2 groups. The group I consisted of patients (n = 31) in which the analysis in the follow-up (WBS with 131I, TSH, Tg and antiTgAt) made in the hypothyroid state, and group II patients (n = 13) in which they made after the administration of rhTSH. The presence of 13 symptoms and signs of hypothyroidism was investigated on the day of giving 131I. Quality of life was evaluated using a modified form: the quality of life scale (SF-36) completed on the day of giving 131I. Results. In both groups, serum TSH reached a very good stimulation level, but significantly higher in the group II (group I 30.3-101.5 µlU/mL, group II 68.6-192.0 µlU/mL, p < 0.05). In both groups, TSHstimulated Tg was higher (group I 0.1-546.0 ng/mL, group II 0.1-7517 ng/mL) comapred to value during the Lthyroxine therapy (group I 0.1-495.0 ng/mL, group II 0.1- 2785 ng/mL). There was no difference in technical quality of WBS obtained from both groups. The patients in the group I had attended 8-13 symptoms of hypothyroidism, while patients in group II did not have symptoms of hypothyroidism. The patients after application of rhTSH, showed statistically significantly better quality of life as compared with those who showed to have L-thyroxine withdrawal, (74-91 points vs 43-62 points; p < 0.05). The rhTSH was well tolerated, with nausea occurring in only one patient. Conclusion. Administration of rhTSH in the follow- up of patients with DTC prevents the debilitating effects of hypothyroidism contributing to the maintenance of metabolic homeostasis of the organism and preserves the quality of life. RhTSH is safe, effective and easy to use, but is still an expensive product in our country.

HeadHER1/EGFR is known to play a pivotal role in tumorigenesis and is overexpressed in up to 80% of NSCLCs. The study of an Expanded Access Clinical Program of Erlotinib in NSCLC is a phase IV openlabel, non-randomized, multicenter trial in patients with advanced (inoperable stage IIIb/IV) NSCLC who were eligible for treatment with erlotinib but had no access to trial participation. Patients for the study from Bosnia and Herzegovina (B&H) were selected from two Clinical centres (Sarajevo and Banja Luka). The aim of study was to evaluated efficacy and tolerability of erlotinib monotherapy in this setting. All patients who received at least one dose of erlotinib and data were entered in the database as of the CRF cut-off date of 14th May 2008 were included in analysis of data (n = 19). This population is defined as the Intent to Treat (ITT) population and includes all patients who had at least one dose of erlotinib regardless of whether major protocol violations were incurred. The findings are consistent with the results of the randomized, placebo-controlled BR.21 study. Indicating that erlotinib is an effective option for patients with advanced NSCLC who are unsuitable for, or who have previously failed standard chemotherapy. In B&H group of patients DCR was almost 84%, and PFS was approximately 24,7 weeks (compared with 44% and 9,7 weeks for erlotinib reported in phase III). Almost three quarter of the patients received erlotinib as their second line of therapy. Overall, erlotinib was well tolerated; there were no patients who withdrew due to a treatment-related AE (mainly rash) and there were few dose reductions. 24% of patients experienced an SAE (most commonly gastrointestinal (GI) disorders).