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The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)", caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions.To centralize the accumulative knowledge on non-pharmaceutical interventions (NPIs) against COVID-19 for each country under one worldwide consortium.International COVID-19 Research Network collaborators developed a cross-sectional online-survey to assess the implications of NPIs and sanitary supply on incidence and mortality of COVID-19. Survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies and incidence and mortality were examined by multivariate regression, with log-transformed value of population as an offset value.Majority of countries/territories applied several preventive strategies including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial mask (94.6% at hospital; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to recommendation to use soap did. Deprivation of mask was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic level. Mask deprivation was pervasive regardless of economic level.NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease incidence and mortality of COVID-19. This article is protected by copyright. All rights reserved.

In the hilly Balkans, a folk proverb has been circulating for a long time, „It is most difficult to be a prophet in one‘s own village“, which reflects the age-old mistrust of the population towards new ideas. This is not surprising in the least, because since the written history of the peoples of the Balkans has existed, a continuous series of conquerors and local rulers who subjugated the common folks and imposed their world view can be traced. Nevertheless, from time to time, people with great strength appear who not only break the shackles imposed by the powerful, but through their actions find a way to the souls of their compatriots and gain their unreserved trust. One of such spontaneous creators is professor Izet Mašić, who achieved a miracle of medical publishing in his Sarajevo and Bosnia and Herzegovina and traced the path of medical science. There may be thousands of medical journals in the world, more or less reputable, and researchers from the Balkans can publish their work in them, but only domestic medical journals can initiate and direct domestic medical research, and educate young researchers in the right way. Professor Mašić made it possible for authors from Bosnia and Herzegovina and other Balkan countries to present their results to the world and receive an incentive from impartial experts to continue their work and progress more and more by editing and publishing three domestic journals at once, which are visible in the most important world bases,. The progress in research then translated into improving medical practice and health care of the population. The following details from Professor Mašić‘s biography tell us how this miracle happened. This year, academician Izet Mašić, Editor-in-Chief of a few biomedical journals, including Acta Informatica Medica journal, celebrates his 70th birthday and also 45 years of his academic and scientific work.

Background: Accurate human body composition assessment is becoming very important in clinical practice due to the possibility of early diagnosis and preventive interventions of metabolic disorders. Fats are one of the most important elements in maintaining normal body structure and different methods are used to determine its total amount and distribution. The amount and distribution of abdominal white adipose tissue, and especially the visceral type, provides important parameters in the development assessment of central obesity, insulin resistance, diabetes and other chronic non-infectious diseases. Objective: The aim of the study was to determine the amount of visceral adipose tissue in adults who are overweight and then estimate the probability of developing insulin resistance (IR) in those with higher amounts of visceral adipose tissue. Based on a comparison of the amount of visceral adipose tissue and the frequency of IR, evaluate the clinical significance of a routine procedure for body structure assessment in relation to the amount of visceral adipose tissue. Methods: Subjects were adults of both sexes aged 20 to 77 years, who were patients in two family medicine clinics. Including criteria for the study were: increased body weight (BMI≥25) and normal blood glucose values (4.0 – 5.4 mmol/L). All subjects underwent anthropometric measurements (BMI, waist circumference, waist-hip ratio) and body structure assessment with bioelectrical impedance. According to the values for the amount of visceral adipose tissue (below and above 110 cm2), the subjects were divided into two groups. All subjects underwent an IR test. We used the HOMA 1 value of 2 as a cut off for the risk of chronic non- infectious diseases in non-diabetic population. Results: The study included 80 patients. 14 patients did not complete the study, so the total number of subjects was 66 (39 women and 27 men). 36 subjects had elevated values of visceral adipose tissue (over 110 cm2). In this group, the presence of IR was registered in 30 patients or 81%. In the control group with a normal amount of visceral adipose tissue, IR was registered in 10 subjects or 33%, which is a statistically significant difference. Conclusion: Increased amount of visceral adipose tissue in overweight patients significantly affects the occurrence of IR. For the patients with an increased amount of visceral adipose tissue, it is necessary to introduce intensive preventive measures to stop the development of diabetes and other complications as a result of IR presence.

The decision of the citation database to include or not include a journal is not subject to the control of another entity, or the professional public, and there are no internationally established ethical standards that the citation database would have to apply. As a consequence of the absence of control, the already mentioned offensive reviews and arbitrary interpretation of the criteria for journal inclusion appear. Given that a journal’s entry into the citation database is a condition for its long-term survival, people who make decisions in the citation databases gain the power to shut down or revive certain journals based on personal preferences. Any power that is not controlled is eventually abused. Therefore, our proposal is to urgently establish the principles of ethical behavior of citation databases at the global level and find ways to ensure compliance with such principles.

Background: Thromboembolic complications are a frequent occurrence during COVID-19. This report presents a patient with signs of subclavian steal syndrome (SSS) caused by a thrombus in the initial part of the right subclavian artery. Pathological occlusive changes, such as thrombosis, are four times more common on the left subclavian. Thrombosis of the subclavian artery occurs in about 1% of the population, but atherosclerotic changes are common and usually asymptomatic. Objective: The aim of this report is to present a patient with signs of subclavian steal syndrome (SSS) caused by a thrombus in the initial part of the right subclavian artery associated with symptoms of COVID-19. Case report: A 56-year-old female patient presented with tremor, numbness and prickling in the right hand, tinnitus, blurred vision, vertigo, syncope, trismus and headaches. The formation of a thrombus caused neurological symptoms in the right hand with a stronger pronounced tremor, headache and syncopal episodes. Routine CT with angiography did not reveal significant subocclusions of the neck arteries or significant ischemic changes in the brain. The patient was treated as Parkinsonismus (disease) with syncopal and collapsing episodes. Due to worsening subjective complaints, CT angiography of the neck and head blood vessels was repeated with iterative 3D reconstruction. The examination, as mentioned above, revealed atherosclerotic changes with thrombosis and stronger subocclusion of the right subclavian artery (RSA) proximal to the origin of the arteria vertebralis. Both vertebral arteries, as well as arteria basilaris, had a normal appearance. During physical exertion of the right arm doppler examination of neck blood vessels revealed the presence of reverse blood flow in the right vertebral artery. Haematological tests and high D-dimer also confirmed the diagnosis. After anticoagulant therapy, the thrombotic mass on the mural calcified RSA plaque disappeared. With the reduced physical strain on the right hand and a lifestyle change, syncopal conditions and headaches stopped. There was a reduction in tremors and tingling in the right hand as well. Conclusion: We reported a case of subclavian steal syndrome caused by thrombosis associated with OVID-19. Thromboembolic complications are common in the course of this disease. The diagnosis was confirmed with advanced diagnostic tools (CTA with 3D reconstruction), laboratory tests (D-dimer) and doppler ultrasound. When routine CT angiography is not completely clear, 3D reconstruction is necessary.

We could say that traditional healing is a way of healing that has been common since ancient times. It has been passed down from generation to generation for many centuries. Magic medicine, although not approved by any of the monotheistic religions present in Bosnia and Herzegovina, and strictly prohibited by Islam, in the form of various magical acts and spells, exists among the people. Some of these magical practices have their roots in the pre-Christian Slavic period and earlier.The aim of this article was to provide the review of the traditional medicine during the history and today in Bosnia and Herzegovina.Review of the available literature, personal contacts and personal experience in contact with the traditional medcine.Some of these magical practices have their roots in the pre-Christian Slavic period and earlier. Since the cause of the disease was usually associated with evil beings of supernatural powers, a deity or God's will or punishment, it is understandable that priests have long been engaged in healing. Especially in the mentally ill, there seemed to be a certain divine or demonic origin of the disease. Muslim folk medicine divides diseases into two groups; in fevers and obsessions with unclean spirits. Folk medicine knows the healing properties of herbs and other substances of animal or mineral origin. The medicinal properties of simple foods that can be found in every home are also widely used, such as: milk, honey, vinegar, oil, onion, and garlic. Prescription books, known as "ljekaruše", were created by collecting and writing down folk remedies. They were written mostly by Catholic priests. "Witch doctors" or "healers" have been preserved in Orthodox monasteries.Traditional medicine is important for history of medicine, ethnology, anthropology, and abounds in folklore elements. It is an area that leads to knowing, understanding or feeling the very nucleus of a nation.

Background The corona virus is transmitted in three ways: by direct contact with an infected person, by droplets, and by air. Transmission control according to official guidelines can be prevented by keeping a distance, wearing a mask and washing hands. Sharing a space with several members of the immediate or extended family increases the risk of transmission in all three ways. In Traditional Bosnian families two or three generations live in one household. The family doctor is informed with living conditions of the residents and has the opportunity to monitor the rate of secondary transmission from the index case, and then recommend additional preventative and treatment measures. Objective The aim of the study was to determine the first occurrence of the symptoms and to monitor possible intrafamilial transmission of the disease through clinical examinations and microbiological-serological tests. Methods The study was conducted in a family medicine clinic in the region of northeastern Bosnia and Herzegovina from March to December 2020. Patients with symptoms that could indicate the presence of COVID-19 disease were registered. If COVID-19 was proven, the patient became an index case. The other members of the family would be monitored for the secondary transmission via laboratory (PCA SARS-CoV-2 and IgM and IgG antibodies) and clinical parameters. Results Characteristics of 25 index cases were analyzed. All 25 of them were middle-aged men that worked outside the home. In 25 households, there was a total of 123 members that shared a home with the index patient. Secondary transmission developed in 76 out of 123 family members (61.8%). Only one patient had a severe form of the disease and was hospitalized. 2 patients died. Conclusion Intrafamiliar transmission of Covid-19 in households of Bosnia and Herzegovina is high. The secondary attack rate of SARS- CoV-2 in households is 61,8%. In the surveyed households, family members use common rooms with an infected patient, and the customs of family gatherings are maintained, without the implementation of protective measures. The family medicine team has the opportunity to apply appropriate preventive action, education and early prehospital treatment as well as adequate selection for the hospital admission.

Background: Haematochesia (Lower Gastrointestinal Bleeding (LGIB) is the most common reason for endoscopic examination. Generaly it is caused by hemorrhoids and diverticular disease, but other anorectal conditions can also lead to LGIB. Recurrent bleeding may result in secondary iron deficiency anemia. Colonoscopy is the primary diagnostic option for establishing a diagnosis of colonic bleeding. Objective: This study aimed to analyze symptoms and endoscopic finding (specialy hemorrhoids) who may be sources of LGIB.Second goal of this study is to estimate time from onset of symptoms to performance of a colonoscopy. Methods: A retrospective study included 603 adult patients who underwent colonoscopy in General Hospital “Sv. Apostol Luka“, Doboj, Bosnia and Herzegovina, between 1.1.2020 and 31.12.2020. Results: Average age of the examined population was 62±13,3years. According to the gender they were mostly men. To be exact,by percentage it was 53.7% of men and 46,3% of women, or by number: 324 men and 279 women. The most common indications for colonoscopy were LGIB (48,8%), abdominal pain and irregular stool. Most frequent endoscopic findings were hemorrhoids 42%. Normal findings had almost one third of all examinated patients. Combined findings-presence of more clinical entities in one patient were presented in 95 cases. In the group with hemorrhoids were almost two thirds of males, but there was no gender difference noted in between group with LGIB and without LGIB. More than half patients were older than 61 years. Anemia was presented in almost 20% of cases. Significantly it is higher frequency of abdominal pain, irregular stool and weight loss observed on the group without LGIB. Also, significantly more frequently patients with LGIB underwent colonoscopy in 0-30 days when compared with patients without LGIB (p=0,016). Conclusion: In patients with haematochezia, taking a careful medical history is mandatory. Hemorrhoids, diverticular disease and colorectal cancers are the most common causes of bleeding. Patients with LGIB and abdominal pain were previously examined with colonoscopy. Completely colonoscopy is advocated to detect probable proximal lesions.

Background Previous pandemic and catastrophic events significantly changed the life of every human being, bringing him/her into a state of stress and the need to quickly adapt to new ways of daily activity. COVID-19 has a negative impact on all elements of health: social, physical and mental. Pharmacotherapy, as well as protective measures (isolation, wearing masks and maintaining physical distance) did not give the expected results. Vaccination has not yet led to herd immunity, so it is still jeopardizing every aspect of human health (1, 2). Non-pharmacological methods, such as stress and sleep control, physical activity and contact with nature are of great importance since they can significantly contribute to staying healthy during a pandemic. Objectives The aim of this paper is to evaluate the impact of non-pharmacological measures such as stress and sleep control (with different measures against the negative effects of anxiety and depression on mental state) and the possible positive impact of "forest bathing" on improving the immune response to the virus and its consequences. Methods Available evidence-based studies on ways to com- bat stress and the effect of the proposed measures on human mental health and the im- mune system were analyzed. From the mentioned studies, recommended measures have been registered, which refer to stress and sleep control, diet and eating habits, contact with nature ("forest bathing", gardening), virtual communication and meditation (mindfulness practice). Results and discussion The combined results of these studies indicate that COVID-19 has a chronic course and complications that significantly affect the physical, mental and emotional state of the patient. Proven positive effects of non-pharmacological measures can be applied in the daily practice of primary health care in the comprehensive fight against the COVID-19 pandemic. Conclusion Non-pharmacological measures such as stress and sleep control, spending time in nature, healthy diet, and physical activity may improve the immune response to COVID-19. These measures, with their positive effects on all aspects of health, can make a major contribution to controlling and improving the quality of life during the COVID-19 pandemic.

Background: Multiple Life and health directly depend on food and normal digestive system functions, as well as eating habits. Absorbed essential and beneficial nutrients from food are used by all human organic systems to maintain their functions for the purpose of maintaining health. The immune system resists harmful agents from the environment and increases level of its activity during infection. Such activity requires more energy sources and specific substrates from food to activate cellular and biochemical elements of immune defense. Adequate food choices and a wide range of nutrients are necessary to maintain optimal immune system function. In the fight against the COVID-19 pandemic, little attention is paid to strengthening the natural abilities of the human body and its immune system to prevent COVID-19. Objectives: The goal of this article is to evaluate new findings on the impact of food, specific nutrients and eating habits on immune system function during the COVID-19 pandemic. Methods: The available literature was analyzed using the key words: food, immune system, COVID-19, and the results of studies that have scientific evidence (EBM) for the positive impact of food on the activity of the immune system during this disease were summarized. Results and discussion: Food, diet and digestive function play the most important role in the overall immune response to viral infections. It has been proven that the active ingredients of food can strengthen or weaken the immune system (immunomodulation or immunosuppression). Organic balanced food adapted to each person (personal diet) is the first condition for creating an adequate natural defense system. Conclusion: There is evidence that many nutrients have key roles in boosting immune system. Strong immune system with adequate response can stop virus entering deeply in human body („to stop virus on the gate“).

Background: Enormous number of medical journals published around the globe requires standardization of editing practice. Objective: The aim of this article was to enlist main principles of editing biomedical scientific journals adopted at annual meeting of Academy of Medical Sciences of Bosnia & Herzegovina (AMSB&H). Methods: The evidence for writing this Guideline was systematically searched for during September 2020 in the PUBMED and GOOGLE SCHOLAR databases. The inclusion criteria were: original studies, systematic reviews, invited expert opinions, guidelines and editorials. The exclusion criteria were narrative reviews and uninvited opinion articles. The retrieved evidence was analyzed by members of the AMSB&H, then discussed at 2020 annual meeting of the AMSB&H and adopted by nominal group technique. Results: In total 14 recommendations were made, based on A to C class of evidence. The editors should educate potential authors and instruct them how to structure their manuscript, how to write every segment of the manuscript, and take care about correct use of statistical tests. Plagiarism detection softwares should be used regularly, and statistical and technical editing should be rigorous and thorough. International standards of reporting specific types of studies should be followed, and principles of ethical and responsible behavior of editors, reviewers and authors should be published on the journal’s web site. The editors should insist on registration of clinical studies before submission, and check whether non-essential personal information is removed from the articles; when essential personal information has to be included, an article should not be published without signed informed consent by the patient to whom these information relate. Conclusions: Principles of editing biomedical scientific journals recommended in this guideline should serve as one of the means of improving medical journals’ quality.

Background From 2013 the World Medical Association's Declaration of Helsinki explicitly requires pre-registration of a study involving human subjects. The registration gives a chance for improvement of design and avoidance of bias. Objective The aim of this article was to describe process of bearing decision to create regional registry of clinical studies for Balkan countries. Methods After finding relevant studies about research registries and designing the concept and structure of future regional registry an article was published in IJBH journal. The article was than used as basis for discussion at 2020 meeting of Academy of Medical Sciences of Bosnia and Herzegovina (AMSBH), and final decision was made by the Academy to create the research registry. Results Regional registry of clinical studies will be under the auspices of AMSBH and web-based, with the option of online registration of new studies. The data required to be entered in the moment of registration relate to key elements of research plan: topic, variables, sample, type of the study and the study population. After applying for registration of a clinical study, the authors will soon receive the review made by the AMSBH expert committee. The application could be accepted, rejected or returned for major or minor revision. After an application is accepted, it will be deposited in the searchable database and given the registration number. Conclusion The AMSBH's decision to create the regional registry of clinical studies will satisfy needs of researchers from Balkan countries in the first place, who share cultural and lingual similarities. It will also help with increasing standards of clinical research in the region.

INTRODUCTION: COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease World Health Organization (WHO) declared the official name as COVID-19 in February 2020 and in 11(th) March 2020 declared COVID-19 as Global Pandemic In June 6(th) 2020, over 7 million cases registered in the world, recovered 3 4 million and death over 402 000 AIM: The aim of this study is to retreive published papers about COVID-19 infection deposited in PubMed data base and analyzed current results of investigations regarding morbidity and mortality rates as consequences of COVID-19 infection and opinions of experts about treatment of afected patients with COVID-19 who have Cardiovascular diseases (CVDs) METHODS: It's used method of descriptive analysis of the published papers with described studies about Corona virus connected with CVDs RESULTS: After searching current scientific literature (on PubMed till today is deposited more than 1 000 papers about COVID-19 with consequences in almost every medical disciplines), we have acknowledged that till today not any Evidence Based Medicine (EBM) study in the world Also, there are no unique proposed ways of treatments and drugs to protect patients, especially people over 65 years old, who are very risk group to be affected with COVID-19, including patients with CVDs Vaccine against COVID-19 is already produced and being in phases of testing in praxis in treatment of COVID-19 at affected patients, but the opinions of experts and common people whole over the world about vaccination are full of controversis CONCLUSION: Frequent hand washing, avoiding crowds and contact with sick people, and cleaning and disinfecting frequently touched surfaces can help prevent coronavirus infections are the main proposal of WHO experts in current Guidelines, artefacts stored on a web site Those preventive measures at least can help to everybody, including also the patients who have evidenced CVDs in their histories of illness Authors analyzed most important dilemmas about all aspects of CVDs, including etipathogenesis, treatment with current drugs and use of potential discovered vaccines against COVID-19 infection, described in scientific papers deposited in PubMed data base

Introduction Pseudo journals, hijacked journals, fraudulent journals, fake journals, and predatory journals waste valuable research when authors publish their studies in them. Aim This article described novel suggested features for the identification of fraudulent journals and aimed to explain this issue to help inexperienced scientists avoid publishing in predatory journals. Methods The articles related to this topic in were retrieved from PubMed and trustable Internet sources. Results Unfortunately, some fake journals have made their way into reputable databases, such as PubMed, PubMed Central, MEDLINE, SCOPUS, and Web of Science; thus, the serious question has been raised regarding how we should address this problematic phenomenon. We recommended 28 suggested characteristics of predatory journals for readers to take into consideration. Conclusion Unaware of the detrimental effects associated with publishing in disreputable journals, inexperienced researchers can fall victim to them. Together, as both readers and writers, we should completely boycott predatory journals.

Introduction COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, first identified in the city of Wuhan, in China's Hubei province in December 2019. COVID-19 was previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease before the World Health Organization (WHO) declared the official name as COVID-19 in February 2020. Aim The aim of this study is to search scientific literature in the biomedicine and analyzed current results of investigations regarding morbidity and mortality rates as consequences of COVID-19 infection of Cardiovascular diseases (CVD), and other most common chronic diseases which are on the top mortality and morbidity rates in almost all countries in the world. Also, to propose most useful measures how to prevent patients to keep themselves against COVID-19 infection. Methods We used method of descriptive analysis of the published papers with described studies about Corona virus connected with CVD, and, also, Guidelines proposed by World Health Organization (WHO) and European Society of Cardiology (ESC), and some other international associations which are included in global fighting against COVID-19 infection. Results After searching current scientific literature we have acknowledged that not any Evidence Based Medicine (EBM) study in the world during last 5 months from the time when first cases of COVID-10 infection was detected. Also, there is no unique proposed ways of treatments and drugs to protect patients, especially people over 65 years old, who are very risk group to be affected with COVID-19. Expectations that vaccine against COVID-19 will be produced optimal during at least 10 months to 2 years, and in all current Guidelines most important proposed preventive measures are the same like which one described in Strategic documents of WHO, in statements of Declaration of Primary Health Care in Alma Ata in 1978. Conclusion WHO proposed preventive measures can be helpful to everybody. Physicians who work at every level of Health Care Systems, but especially at primary health care level, must follow those recommendations and teach their patients about it. But, the fact is that current focus of COVID-19 epidemic has targeted on protection of physical health of population in global, however, the influence on mental health which will be one of the important consequences of COVID-19 pandemic in the future, and which could be declared as «Post-coronavirus Stress Syndrome" (PCSS) could be bigger challenge for Global Public Health.

Background: Accurate estimations of hepatitis B virus transmission risk for any region in Bosnia and Herzegovina are not clearly established. We aimed to determine levels of risk associated with intrafamilial transmission of hepatitis B infection within families in our region. Patients and Methods: Family members of 81 chronic carriers of hepatitis B surface antigen (>6 months positive and considered as index case) were tested for hepatitis B markers. For family members, we recorded their age, sex, and family relationship to the index case, and vaccination status. Results: The proportion of HBsAg positive family members was 25/207 (12.1%), while the proportion of family members with evidence of exposure to HBV was 80/207 (38.6%). Only 17/207 (8.2%) family members had evi--dence of past HBV vaccination. Age was found to be a significant predictor of HBV exposure of family members (odds ratio 1.05, 95% CI 1.03-1.07, P< .001). In a multivariate analysis, HBsAg positivity was associated with a female index case (odds ratio 11.31, 95% CI 3.73-34.32, P< .001), HBeAg positivity in the index case (odds ratio 5.56, 95% CI 1.80-17.23, P< .005) and being a mother of the index case (odds ratio 9.82, 95% CI 2.43-39.68,P< .005). A female index case (odds ratio 4.87, 95% CI 2.21-10.72, P< .001), HBeAg positivity in the index case (odds ratio 3.22, 95% CI 1.15-9.00, P< .05) and being a mother of the index case (odds ratio 3.72, 95% CI 1.19-11.64, P< .05) were also risk factors for HBV exposure among family members. The combination of HBeAg positivity and female index case was a significant predictor for HBsAg positivity of family members (odds ratio 70.39, 95% CI 8.20-604.61, P< .001). Conclusions: Children of HBeAg positive mothers are at highest risk for becoming chronic carriers them--selves and generally, the combination of female sex and HBeAg positivity dramatically increases the chances of HBV transmission within the family.

OBJECTIVE To establish an optimal age threshold for endoscopy referral in patients with simple uninvestigated dyspepsia in the setting of European developing country (Bosnia and Herzegovina) with low availability and high workload of endoscopy units. METHODS We reviewed patient information on all upper endoscopies performed during a 6-year period (2000-2005). Different age thresholds were evaluated in terms of their predictive power for absence of malignancy. RESULTS A total of 82 of 4403 (1.86%) dyspeptic patients had upper gastrointestinal (GI) malignancy. Age cutoffs of 40 years for men and 45 years for women had the best predictive power, without any cases of upper GI malignancies below those thresholds. Age cutoffs of 45 years for men and 50 years for women also had excellent negative predictive values (99.7 and 99.9%, respectively) with 1.45 and 0.98 cases of missed upper GI malignancies per 1000 endoscopies, respectively. A total of 1709 of 4403 (38.8%) of endoscopies might have been avoided in men of less than 45 and women of less than 50 with uninvestigated dyspepsia. CONCLUSION (i) Age thresholds for endoscopy referral are lower than in Western countries and should be different for men and women. (ii) Cutoff values of 40 and 45 years for men and women, respectively, are completely safe to use. (iii) Thresholds of 45 years for males and 50 years for females have a small level of risk of missing upper GI malignancy, but are acceptable to use in areas of low availability of endoscopy.

Introduction: Gastric MALT lymphoma accounts aproximately 7% of all gastric tumors. Women are mostly affected by this disease (mean age 60 years). The aim of this study was to determine the incidence of gastric MALT lymphoma in the Endoscopy Unit of the Department of Gastroenterology Of University Clinical Center Tuzla, the degree of histological malignancy and correlation with the Helycobacter pylori infection and then to evaluate the effectiveness of triple-antibiotic therapy (protonic pump inhibitors and antacides) in treatment of these cases. Patients and methods: All the patiens in the study were performed with gastroscopy and mucosal tissue biopsy in the Endoscopy Unit of the Department of Gastroenterology of UKC Tuzla. PHD and IHH analysis of the given material were performed in the Patology Department of UKC Tuzla. The blood analyses on H. Pylori were done in the Department of Microbiology of UKC Tuzla. Results: 112 patients with gastric tumors were involved in this study, 91 of whom suffered from malignant tumors, six of them had MALT lymphoma (five of them had confirmed H. pylori infection, four had histologically confirmed low-grade tumors and two was categorised as high grade malignancies). Histological lesions were classified according to the actual Ann Arbor classification. Patients with high malignancy risk underwent the operative procedures, and then were treated by polychemiotherapy (CHOP protocole, VI-VIII cikluses). All the patients with confirmed H. pylori infection were treated with antibiotics for 2-4 months, after which complete eradication was accomplished in all cases. Patients histologicaly diagnosed with low grade malignancy showed complete histological regression. In addition to that, after triple antibiotic therapy none of the patients presented with the disease transformation into another histological form. Discussion and Conclusion: The results of this study prooved high incidence in use of triple antibiotic therapy in treatment of patients who suffer from MALT lymphoma with confirmed H. pylori infection. Besides, it is very important to emphasise the fact that patients had no side-effects during polychemiotherapy which was used to treat all the patients regardless of their histological type and malignancy degree of MALT lymphoma.

Objective To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. Methods A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. Results Prevalence of hepatitis B surface antigen was higher (P

Introduction: Cardiovascular diseases (CVD) are the leading death cause in modern world and are the most public health problem. WHO program for CVD contains: prevention, command and follow up of CVD in global level. Aim: Investigate CVD frequency in family medicine team in 2012.year (one year period of time) and qualitative management prevention and clinical services management quality of CVD together with recommended standards. Patients and methods: clinical revision of clinical standard practice patients with CVD was provided in Family medicine team in Public Health Centre Tuzla for the period of time from January 01 2012 - December 31 2012. For quality of realized services, AKAZ standards were based for: chapter 2. Health promotion and diseases prevention 2.5. preventive clinical services; chapter 3. Clinical services, standard 3.1. Coronary diseases and standard 3.2. TIA and Stroke. From CVD register next parameters had been used: age, gender, disease diagnose, therapy, blood pressure values, total cholesterol values, ß blockers therapy, anticoagulant therapy prescription, smoker status, stop smoking recommendation and influenza vaccination recommendation. Statistical approach: All results were taken in Excel program and statistically analyzed. Descriptive standard tests were taken with measurement of central tendency and dispersion. For significant differentials achieved with χ² chances relation was taken (Odds Ratio-OR) with 95% relevant security. All tests were leveled in statistical significant from 95% (p

Introduction: High blood pressure is the cause of almost 13 % of all deaths in the world. DASH (Dietary Approaches to Stop Hypertension) is „gold standard“ in diet recommended by American Society of Hypertension, American Heart Association and Dietary Guidelines for Americans 2010 for reduction many CV risk factors including hypertension. Non-pharmacological treatment of hypertension through DASH dietary program with reduction of salt intake can significantly reduce high values of blood pressure and decrease general cardiovascular risks. Goal: The aim of this research is to determine the prevalence of hypertension among miners in Banovici coal mine and amount of salt taken in meals during work time. Material and methods: We inspected the medical documentation and registers for all employees in coal mine Banovici in order to provide calculation of hypertension prevalence. Based on reports and company standards on grocery usage and average amount of salt used in preparation of one meal in coal mine kitchen, we have calculated the average consumption of salt of one employee per meal. Results: There are 2700 of employees in coal mine Banovici with average life age of 46 years. From them 694 (25.7%) miners have arterial hypertension. Also 707023 kg of salt is being spent for preparation of meals in coal mine kitchen on yearly basis. Employees take between 4-9 grams of salt per one meal excluding the salt contained in bread. Conclusion: the amount of salt intake per one meal in the coal mine kitchen is larger from daily doses recommended by ACC/AHA.

Introduction: Laryngopharyngeal reflux disease (LPRD) referes to an inflammatory reaction of the mucous membrane of pharynx, larynx and other associated respiratory organs, caused by a reflux of stomach contents into the esophagus. LPRD is considered to be a relatively new clinical entity with a vast number of clinical manifestations which are treated through different fields of medicine, often without a proper diagnosis. In gastroenterology it is still considered to be a manifestation of GERD, which stands for gastroesophageal reflux disease. Patients suffering from LPRD communicate firstly with their primary physicians, and since further treatment might ask for a multidisciplinary approach, it is important to have a unified approach among experts when treating these patients. Goal: This paper is written with the intention to assess the frequency of symptoms of LPR in family medicine, possible diagnostics and adequate treatment in primary health care. Materials and methods: This is a prospective, descriptive cohort study. Authors used „The Reflux Symptom Index” (RSI) questionnaire. Examinees were all patients who reported to their family medicine office in Gracanica for the first time with new symptoms during a period of one year. Patients with positive results for LPR (over 13 points) were treated in accordance with the suggested algorithm and were monitored during the next year. Results: Out of 2123 examinees who showed symptoms of LPR, 390 tested positive according to the questionnaire. This group of examinees were treated in accordance with all suggested protocols and algorithms. 82% showed signs of improvement as a response to basic treatment provided by their physicians. Conclusion: Almost every fifth patient who reports to their family medicine physician shows symptoms of LPR. On primary health care levels it is possible to establish some form of prevention, diagnostics and therapy for LPR in accordance with suggested algorithms. Only a small number of patients requires procedures which fall under other clinical fields.

AIM To analyse the difference in documentation of standard parameters for monitoring DM type 2 between Family Medicine Teams (FMT) and Teams on Program Additional Training (PAT). METHODS Study was conducted as 20 medical chart audits of diabetic type 2 patients randomly selected per 3 FMT from Zenica and 3 PAT from Kakanj. According to the chart, we assess sex, age, glucose in blood-GB, blood pressure-BP, total cholesterol-TC, body mass index-BMI, HbA1c, foot exam, eye exam and urinoanalisis and have any of the tests been done in the past year. RESULTS 60 medical chart from FMT and 60 medical charts from PAT teams were reviewed. FMT vs. PAT teams recorded: BG 58% vs. 30% (X2 = 8.651, p = 0.003); BP 70% vs.33% (X2 = 14.716, p = 0.0001); TC 35% vs.22% (X2 = 2.011, p = 0.156); BMI 48% vs.28% (X2 = 4.266, p = 0.038); HbA1c 41% vs.75% (X2 = 12.377, p = 0.0004); foot exam 26% vs. 78% (X2 = 28.158, p < 0.0001); eye exam 48% vs. 65% (X2 = 2.749, p = 0.097) and urinoanalisis 38% vs.88% (X2 = 30.179, p < 0.0001). CONCLUSION FMT recorded a higher number of metabolic parameters for macrovascular risk factors (BG, BP and BMI) than microvascular risk factors (HbA1c, foot exam and urinoanalisis) which are were better controlling by PAT teams.

Background Pain in the lower abdomen is one of the leading reasons that lead the patient in surgery. Although appendicitis is the most common cause in about two thirds of patients the other causes must be taken into account. Objectives To determine the probabilities which could determine what is an etiological cause of pain. Materials and methods comprised 102 patients hospitalized in general hospital Tesanj because the clinical symptoms dominated by acute pain in the lower abdomen. The study was retrospective prospective clinical study. All data were collected in a special database and statistically analyzed. Results Of all the causes of abdominal pain in the lower abdomen the most common is appendicitis with a total of 62 patients, of which slightly more male patients (36) compared to female patients (26) or (57% male and 43% female patients). If we analyze the time elapsed from pain onset to patient visit of physician we can say that patient with more intense pain will visit physician sooner. Colic and intense pain is a characteristic of colon cancer (15 patients) and Crohn's disease. Dull pain is characteristic of omentum cyst, diverticulitis, and intestinal obstruction and was seen in one fifth of patients with colorectal cancer and one third of patients with acute appendicitis. Palpatory positive pain in Mc Burney's point distinguishes appendicitis from other causes in most cases. Discussion The decision-making in the treatment of abdominal pain is depending of nature of pain, intensity, spreading, and sensitivity to palpation and localization of pain that usually indicates the place where the sick organ transmits the inflammatory process to the parietal peritoneum. Other symptoms that accompany pain and laboratory tests can be of crucial importance.

Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam.Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries.Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina.There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. AE departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through practice.The Development of emergency medicine as a separate specialization and independent academic discipline has had different way and pace of development, and there is no ideal model that can be applied in all countries. However experiences from countries with well developed emergency medicine, suggest that the model of the simultaneous development of emergency medicine as a distinct academic discipline on independent recognized residencies with a strong national association is the best way for the formation of an efficient health system. The establishment of Emergency centers--departments for emergency medicine at university and cantonal hospitals, introduction of emergency medicine as an academic discipline, implementation of specific post-graduate teaching and continuing medical education through appropriate courses, as well as academic development program for the teaching staff is the most important element of future development of this discipline. It would also contribute to it achieving the appropriate status in both the academic institutions and in practice within the health system of Bosnia and Herzegovina.

Hepatic resection is the accepted treatment for various liver tumors. Increasing evidence suggests that two factors significantly influence outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis. There are liver function recovery and the degree of inflammation during early postoperative period.Aim of this study was to determine whether probiotic use influences on liver function recovery, degree of inflammation during early postoperative period, intraoperative risk, type and frequency of intraoperative and postoperative complications, morbidity, intraoperative and early postoperative mortality and a one-year survival rate in patients who have been used probiotic, and underwent the hepatic resection due to HCC in cirrhosis.Study was conducted on 120 patients underwent the hepatic resection due to HCC in cirrhosis. This study has been done in University Clinical Centers Tuzla, Maribor and Strasbourg from October 2006 till February 2008. Patients were divided into 2 groups: 1) patients with liver cirrhosis and histologically verified HCC whom underwent liver resection surgery (segmentectomy/ bisegmenctetomy, right and left hemihepatectomy/extended hemihepatectomy) that used preoperatively and postoperatively probiotics (n = 60), 2) a control group of patients with liver cirrhosis and HCC, which did not use preoperative and postoperative probiotics (N = 60). Treatment with probiotics was conducted 3 days preoperatively and postoperatively with 7 day's oral supplementation.This study have shown next: patients underwent to the hepatic resection due to HCC in cirrhosis who have been used preoperatively and postoperatively probiotic had liver function recovery better and faster, acute immune response better, serum level of tumor markers lower, intraoperative and postoperative complications were less frequent, and morbidity and mortality rates were lower than in those who have not been using probiotic.Probiotic use may make liver function recovery better and increases immune response in early postoperative period and positively influences outcome and successfulness of the hepatic resection in patients with HCC in cirrhosis.

Patients with eye problems are often present in family medicine and emergency wards, whether it is isolated disturbances of vision, or as part of other diseases. A large number of pathological entities of the eye require prompt and accurate diagnosis and appropriate therapy before they get to specialized ophthalmological institutions. Ultrasonography of the eye is a simple, non-invasive, painless method that can be done at the first contact with patients and can provide very important information for accurate diagnosis of pathological changes. Early detection of retinal ablation, intra ocular bleeding and tumors by this method can save sight and lives of patients. Sonography of the eye in 667 patients over two years revealed 27 retinal ablation and hemophthalmos in 36 patients. Every fifth patient with retinal ablation was referred by a doctor of family medicine. Knowing the possibilities of ultrasonography in ophthalmology, teamwork at the level of primary health care can open access to ultrasonography of the eye for other specialty physicians which can improve population health and provide a new quality in the prevention of vision loss.

Special attention needs to be given to resolution of obesity problem among children because many studies indicate that majority of persons that have suffered from obesity during their child age still have the same problems when they become adults. Incorrect nutritional habits cause health problems at later age. The purpose of this study is to determine the frequency of overweight and obesity occurrence among school-age children, as well as risk factors that certainly lead to obesity.This research was conducted on sample of 530 pupils from one elementary school from suburban area. Assessed children were from seven to fourteen years old. Anthropometric measurements were taken and questionnaires and general medical examinations followed with the statistical processing of collected data.Based on the Body Mass Index (BMI) considering age and gender of examined subjects we have found that 14.7% subjects were overweight and 7.3% of children were obese. Also, we have determined that children often use food that is identified as risk factor for obesity. Overweight and obesity are directly related to amount of time spent in front of TV set or personal computer (p = 0.01). Children that were overweight in 57.1% cases would prefer to change their nutritional habits and 68.4% of obese children would like to do so as well. Children that were obese, in high percent would like to change habits regarding their physical activity (57.9% of them) and overweight children in 33.8% cases.It is necessary to encourage young people to develop healthy nutritional habits, to promote physical activity and sports, and definitely to strongly advice against the sedentary lifestyle. It is crucial to educate parents on healthy nutritional habits and physical activity because they have the strongest influence on their children. Also, effort needs to be taken in schools by increasing number of physical education classes and to provide healthy food in school canteens in order to ensure improvement of physical activity and healthy nutritional habits among children.

Crohn's disease (CD) is a lifelong disease arising from an interaction between genetic and environmental factors, but seen predominantly in the developed countries of the world. The precise etiology is unknown and therefore a causal treatment is not yet available. Fistulating Crohn's disease includes fistulas arising in the perianal area, together with those communicating between the intestine and other organs or the abdominal wall. Non perianal fistulas include fistulas communicating with other viscera (urinary bladder, vagina), loops of intestine (enteroenteral fistulas) or the abdominal wall (enterocutaneus fistulas). The diagnostic approach is a crucial aspect in the management of fistulating CD as the findings influence the therapeutic strategy. Short bowel syndrome caused by extensive bowel resection should be initially treated with nutritional support and can caused serious treatment and reevaluating problems. We review this uncommon manifestation in a high risk patient after multiple operations and severely shortened bowel and also with non perianal fistulating CD.

Colorectal cancer occurs in the familial cancer syndromes in about 2 to 4 percent. The major genetic syndromes are Familial adenomatous polyposis (FAP) and Hereditary nonpolyposis colorectal cancer (HNPCC). FAP is caused by germline mutation of APC gene, and HNPCC is caused by germline mutation in one of five MMR genes. The identification of patients with inherited disease is very important in the management of colorectal cancer. But, it is impractical to test every patient with the disease for these mutations. The clinical and genetical screening programme should be advised for family members at risk and colectomy in affected individuals in purpose to reduce the frequency of colorectal cancer.

Objective: Timely recognition and optimal management of atherogenic dyslipidemia (AD) and residual vascular risk (RVR) in family medicine. Background: The global increase of the incidence of obesity is accompanied by an increase in the incidence of many metabolic and lipoprotein disorders, in particular AD, as an typical feature of obesity, metabolic syndrome, insulin resistance and diabetes type 2. AD is an important factor in cardio metabolic risk, and is characterized by a lipoprotein profile with low levels of high-density lipoprotein (HDL), high levels of triglycerides (TG) and high levels of low-density lipoprotein (LDL) cholesterol. Standard cardiometabolic risk assessment using the Framingham risk score and standard treatment with statins is usually sufficient, but not always that effective, because it does not reduce RVR that is attributed to elevated TG and reduced HDL cholesterol. RVR is subject to reduction through lifestyle changes or by pharmacological interventions. In some studies it was concluded that dietary interventions should aim to reduce the intake of calories, simple carbohydrates and saturated fats, with the goal of reaching cardiometabolic suitability, rather than weight reduction. Other studies have found that the reduction of carbohydrates in the diet or weight loss can alleviate AD changes, while changes in intake of total or saturated fat had no significant influence. In our presented case, a lifestyle change was advised as a suitable diet with reduced intake of carbohydrates and a moderate physical activity of walking for at least 180 minutes per week, with an recommendation for daily intake of calories alignment with the total daily (24-hour) energy expenditure (24-EE), depending on the degree of physical activity, type of food and the current health condition. Such lifestyle changes together with combined medical therapy with Statins, Fibrates and Omega-3 fatty acids, resulted in significant improvement in atherogenic lipid parameters. Conclusion: Unsuitable atherogenic nutrition and insufficient physical activity are the new risk factors characteristic for AD. Nutritional interventions such as diet with reduced intake of carbohydrates and calories, moderate physical activity, combined with pharmacotherapy can improve atherogenic dyslipidemic profile and lead to loss of weight. Although one gram of fat release twice more kilo calories compared to carbohydrates, carbohydrates seems to have a greater atherogenic potential, which should be explored in future.

Acute respiratory distress syndrome (ARDS) is a form of acute life threatening respiratory failure. In daily practice there is difficulty in diagnostic and therapeutic management of Acute respiratory distress syndrome (ARDS). We observed delay in diagnostic and therapeutic procedures in patients with clinical signs for the presence of severe respiratory disorders. Finding timely evidence of the presence the clinical signs of threatening ARDS and underlying diseases like influenza A/H1N1 during prehospital period in early stage of disease it is possible introduce early adequate treatment: high flow oxygen, fluid replacement and pharmacological and antiviral therapy. This measure can reduce high mortality in patients who develop ARDS. It is important to improve diagnostic criteria for a precise definition of ARDS and transfer it in practice of emergency and family medicine, microbiology, intensive care units, hospital departments of infectious and respiratory diseases. In this article we underlined the key elements of the new definition of ARDS, diagnostic criteria and the importance of early diagnosis in prehospital period following clinical feature and course (a presence of severe dyspnea) by adding chest x-ray and laboratory investigations.

Introduction: The prevalence of dyspepsia in the general population worldwide is very high (20-40%). Upper abdominal complaints are one of the most common cause of patients’ visits to primary care settings. Making an accurate etiological diagnosis of dyspepsia is difficult, but is an important challenge and goal for every doctor in primary care practice. Clinical guidelines have standards for gastroesophageal reflux disease, management of Helicobacter infection and indications for the use of endoscopy (empiric treatment, prompt endoscopy, “test and treat”). In spite of the application of those standards, many patients experience no improvement in their symptoms or often the recurrence of disease. Aim: This study presents a new approach to the diagnostic and therapeutic management of uninvestigated dyspepsia in primary care settings to provide long-term effective control of symptoms for family doctors. Material and methods: 3000 unselected consecutive dyspeptic patients underwent abdominal ultrasound, and 1000 dyspeptic patients from the same group upper endoscopy.. In this approach diagnostic evaluation of dyspepsia includes: abdominal ultrasonography as a first line obligatory routine method and the exact estimation of nutritional condition. Results: Abdominal ultrasound, physical examination and BMI control have significant value in the diagnostic evaluation of dyspepsia. The therapeutic approach includes, besides general standards (acid suppressive drugs, eradication of H. pylori, prokinetic and antidepressant agents), life style modification and nutritional interventions as first-line treatments. In this approach the use of new drugs such as ursodeoxycholic acid (UDCA), pre and probiotics, and digestive enzymes supplements is recommended. Conclusion: Throug the combination of different diagnostic procedures as first line methods, including abdominal ultrasound and nutritional condition (BMI), a family doctor can manage successfully uninvestigated dyspepsia at the primary care level.

Introduction: Family medicine as a part of the primary health care is devoted to provide continuous and comprehensive health care to the indi- viduals and families regardless of age, gender, types of diseases and affected system or part of the body. Special emphasis in such holistic approach is given to the prevention of diseases and health promotion. Family Medicine is the first step/link between doctors and patients within patients care as well as regular inspections/examinations and follow-up of the health status of healthy people. Most countries aspire to join the European Union and therefore adopting new regulations that are applied in the European Union. Aim: The aim of this study is to present the role and importance of family medicine, or where family medicine is today in 21 Century from the beginning of development in these countries. The study is designed as a descriptive epidemiological study with data from 10 countries of the former Communist bloc, Slovenia, Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Macedonia, Kosovo, Albania, Bulgaria, Romania, Czech Republic, Slovakia and Hungary, just about half of them are members of the EU. We examined the following variables: socio-organizational indicators, health and educational indicators and health indicators. The data used refer to 2002 and as a source of data are used official data from reference WebPages of family medicine doctors associations, WONCA website (EURACT, EQuiP, EGPRN), WebPages of Bureau of Statistics of the countries where the research was con- ducted as well as the Ministries of Health. Results: Results indicates that the failures and shortcomings of health care organizations in Southeast Europe. Lack of money hinders the implementation of health care reform in all mentioned countries, the most of them that is more oriented to Bismarck financing system. Problems in the political, legal and economic levels are obstacles for efficient a problem reconstructing health care system toward family medicine and primary prevention interventions. The population is not enough educated for complicated enforcement for and prevention of diseases that have a heavy burden on the budget. Health insurance and payment of health services is often a problem, because the patients must be treated regardless of their insurance coverage and financial situation. The decrease in production and economic growth, as well as low gross national income in the countries with economic crisis, lead to the inability of treatment for a large number of the population. Such situation a system leads to additional debts and loans to healthcare system. Measures implemented for provision of acute curative care largely did not lead to improvements in the health status of the population. Educational and preventive measures, as well as higher standards for quality and accessibility of health care services for entire population in each country, especially those struggling are bound to joining the European Union and their implementation must start. The most A large number of medical institutions are is inefficient in health education and health promotion and must work to educate patients and families and increase the quality of preventive health services. Modernization of health care delivery and joining the European Union by increasing overall economic stability of countries is one of the primary goals of all countries in Southeast Europe.

Telemedicine itself is not the medical profession, it is not a medical specialty, but the way in which the medical profession conduct its activity. Therefore we are talking about tele otorhinolaryngology, tele cardiology or tele pathology. In the definition of a multitude of telemedicine that can be found in the literature is the following: Telemedicine is a system that supports the process of health care by providing ways and means for more efficient exchange of information that allows multitude of activities related to health care, including health care and health personnel, including education, administration and treatment. Telemedicine applications include: tele diagnosis, tele consultation, tele monitoring, tele-care, tele consultations and remote access to information contained in one or more databases. It turned out that telemedicine is an important factor in technological, professional, financial and organizational uniformity of development of the health system. Telemedicine, although a new area, to a large extent already changed the ways of providing health care, and even more influence on the ways of designing the future of medicine.

Trichobezoar of gastrointestinal tract is an uncommon clinical condition and can present diagnostic and therapeutic challenge in practice. Clinical manifestations vary from no symptoms to serious complications. Delay in diagnosis may lead to an acute abdominal syndrome with lethal consequences, because of perforation, bleeding and obstruction of gastrointestinal tract. The most useful diagnostic procedure is gastroscopy. Large trichobezoars are difficult to remove endoscopically, so majority of cases require surgery. Case report: We report a unique case of large gastric trichobezoar in young female with nonspecific symptomatology but with palpable huge epigastric mass and rare complications: multiply gastric ulcers and antral polyposis. Conclusion: After operative removal of the bezoars ulcers healed completely, but antral polyposis persists.

Association of Gastroenterologists and Hepatologists of Bosnia and Herzegovina based on the experiences of domestic and foreign centers operating in the field of hepatology and accepted guidelines of the European and the U.S. Association for Liver Diseases adopted the consensus for the diagnosis and treatment of chronic viral hepatitis B and C. The guidelines are intended for specialists in gastroenterology and hepatology, and infectious diseases physicians working in primary health care and family medicine, but also other physicians who are confronted with this disease in their practice, with the aim of facilitating and shortening the diagnostic and treatment protocols of patients with chronic viral hepatitis B and C. This ensures faster, more efficient, more rational and cost-effective care of patients with hepatitis, with an emphasis on stopping the deterioration of liver disease to liver cirrhosis and eventually hepatocellular carcinoma. Key words: Chronic hepatitis B and