Public Health Services in Herzegovina Region during 1992–1995 War

The aim of this study was to describe the situation and the development of Croatian Defense Council medical corps during the 1992–1995 war in Bosnia and Herzegovina. The paper provides an overview and describes the main events that lead to development of the medical care in the wartime conditions, with special emphasis on the public health system in Herzegovina region. This included the creation of three distinctive public health system settings: initial, integral and post-war period, all marked by certain specificities in organization and delivery of the public health and overall health care to both military and civilians. The knowledge and skills gathered during this period can be useful in situations that involve the need for fast public health actions, such as various natural disasters and disease outbreaks, and could be used for establishing highly mobile response public health teams. Furthermore, the experiences gathered during these periods may be useful during the planning phases of the health care reforms, all aiming to deliver the best possible health care to the entire population

Zadovoljstvo bolesnika kvalitetom pruženih usluga u internističkim djelatnostima u Sveučilišnoj kliničkoj bolnici Mostar Patient satisfaction with the quality of services provided in Internal Medicine Departament at the University Clinical Hospital Mostar

Kvaliteta pruženih usluga proces je utvrđivanja zadovoljstva bolesnika zdravstvenim uslugama, uočavanja nedostataka i njihova provođenja. Utvrđivanje zadovoljstva bolesnika pruženim uslugama u zdravstvenim ustanovama koristan je podatak čija je svrha unaprijediti i poboljšati kvalitetu zdravstvenih usluga. U idealnom društvu svi bi bili podjednako zadovoljni, ali u stvarnom životu to nije moguće i stoga je kvaliteta zdravstvene zaštite kompleksna i sporo napreduje. Sudionici su u poboljšavanju kvalitete i sigurnosti zdravstvenih usluga: zdravstveni djelatnici, zdravstveni suradnici, korisnici zdravstvenih usluga, zdravstvene ustanove, zavodi za javno zdravstvo, komore i udruženja zdravstvenih djelatnika, te ministarstvo zdravstva. Zadovoljstvo bolesnika pruženom zdravstvenom uslugom jedan je od glavnih kriterija koji upućuju na razinu postignute kvalitete [1,2]. Cilj je provedenog istraživanja ispitati razinu zadovoljstva kod hospitaliziranih bolesnika u Sveučilišnoj kliničkoj bolnici (SKB) Mostar. U istraživanje su uključena 182 bolesnika, hospitalizirana u periodu od mjeseca travnja do kolovoza 2017. godine. Uporabom anketnog upitnika izrađenogu Agenciji za kontrolu kvalitete u zdravstvu i socijalne skrbi [engl. Hospital Consumer Assessment of Healthcare Providers And Systems] ispitano je njihovo zadovoljstvo. Podaci su obrađeni u statističkom paketu ANOVA (Analiza varijance), Microsoft Excel Data Analysis, Tools-am. Svi aspekti zadovoljstva kvalitetom pruženih zdravstvenih usluga međusobno su pozitivno povezani. Obradom podataka nameće se zaključak kako bi bolja organizacija rada na odjelima i fokusiranje na potrebe bolesnika, uvažavajući njihova očekivanja, bili važni za osjećaj zadovoljstva bolesnika

SOCIOECONOMICS CONDITIONALITY OF SEROPREVALENCE OF HEPATITIS A IN THREE SOUTH-WEST CANTONS OF THE FEDERATION OF BOSNIA AND HERZEGOVINA

The prospective study, which was made from Jan 1st 2009. till Dec 31st 2010. in the Clinic for Infectious Diseases within Clinical Hospital Mostar has been implemented in the areas of three southwestern cantons of the Federation of Bosnia and Herzegovina. We wanted to define the seroprevalence of the researched area using seroepidemiological testing of different groups of the population, based on the distribution by sex, age, education, residence and watersupply. The aim of this research was to prove the hypothesis that the decrease of seroprevalency of Hepatitis A has been directly related to the improvement of socio-economic conditions of life that at the end brought the decrease of the total prevalence in patients in younger age groups. The total of 420 examinees from the reasserted sample were analysed and they were classify into age groups. The first group was for the children up to 10 years. Then the group 11-20 follows and etc up to the last group, that complies examinees older than 60. In this way we have got seven groups of 60 examinees, from which the half of them was urban, and the other half was rural inhabitants. In every group analysed the half of examinees were females and the other half were males. The results we acquired with this research did not show any statistically relevant differences of seroprevalence of Hepatitits A between the urban and rural areas, between the sexes, nor between the populations which used different wattersupply objects. A statistically relevant difference was found between populations of different levels of education, but the most important difference was found between seroprevalency in different age groups. Seroprevalence in younger age groups was substantially low and increased in groups rising with age. Comparing this data to results from other similair researches from developed and undeveloped countries we concluded that the researched area, by the level of seroprevalency of Hepatitis A belongs to the category of developed countries

SOCIOECONOMICS CONDITIONALITY OF SEROPREVALENCE OF HEPATITIS A IN THREE SOUTH-WEST CANTONS OF THE FEDERATION OF BOSNIA AND HERZEGOVINA

The prospective study, which was made from Jan 1st 2009. till Dec 31st 2010. in the Clinic for Infectious Diseases within Clinical Hospital Mostar has been implemented in the areas of three southwestern cantons of the Federation of Bosnia and Herzegovina. We wanted to define the seroprevalence of the researched area using seroepidemiological testing of different groups of the population, based on the distribution by sex, age, education, residence and watersupply. The aim of this research was to prove the hypothesis that the decrease of seroprevalency of Hepatitis A has been directly related to the improvement of socio-economic conditions of life that at the end brought the decrease of the total prevalence in patients in younger age groups. The total of 420 examinees from the reasserted sample were analysed and they were classify into age groups. The first group was for the children up to 10 years. Then the group 11-20 follows and etc up to the last group, that complies examinees older than 60. In this way we have got seven groups of 60 examinees, from which the half of them was urban, and the other half was rural inhabitants. In every group analysed the half of examinees were females and the other half were males. The results we acquired with this research did not show any statistically relevant differences of seroprevalence of Hepatitits A between the urban and rural areas, between the sexes, nor between the populations which used different wattersupply objects. A statistically relevant difference was found between populations of different levels of education, but the most important difference was found between seroprevalency in different age groups. Seroprevalence in younger age groups was substantially low and increased in groups rising with age. Comparing this data to results from other similair researches from developed and undeveloped countries we concluded that the researched area, by the level of seroprevalency of Hepatitis A belongs to the category of developed countries

Prolonged Treatment of Disseminated Echinococcosis – a Case Report

Cistična ehinokokoza (CE), koju uzrokuje E. granulosus, zoonotska je bolest koja se pojavljuje na gotovo svim kontinentima, a endemična je za područje Mediterana. Bolest se najčešće prezentira afekcijom jednog organa i solitarnom cistom, a kod manjeg broja bolesnika radi se o diseminiranoj bolesti koja pogađa višestruke organe. U ovom je radu prezentirana mlada žena s diseminiranom ehinokokozom kod koje su hidatidne ciste verificirane u jetrima, slezeni, plućima, bubrezima i perikardu. Zbog specifičnosti oblika bolesti, dobi bolesnice te zbog čestih relapsa bolesti nakon završetka terapije, liječena je albendazolom kroz duži vremenski period. Želimo prezentirati nešto drugačiji modus liječenja ehinokokokze koji je rezultirao povoljnom regresijom i kontrolom bolesti.Cystic echinococcosis (CE), which is caused by E. granulosus, is a zoonotic disease present in almost every continent and endemic for the Mediterranean. The disease is principally presented with the involvement of a single organ and mainly with solitary cyst but in the smaller number of patients it can be a case of disseminated disease affecting multiple organs. In this report we present a young woman with disseminated echinococcosis with multiple hydatid cysts verified in liver, spleen, lungs, kidneys and pericard. Due to the specific form of disease, patient`s age and common relapses after the end of therapy, the patient was treated with albendazole for a prolonged period of time. We would like to present a somewhat different approach to the treatment of echinococcosis which resulted in regression and better control of the disease

Epidemiological and clinical features of brucellosis in children

Cilj: U strukturi pobola mediteranskih zemalja, me|u koje spada Bosna i Hercegovina, bruceloza zauzima važno mjesto zbog svojih socijalno-medicinskih značajki. Bolest ima široki spektar kliničkih manifestacija i može dovesti do komplikacija s teškim posljedicama. Cilj ovog istraživanja bio je prikazati kliničke i epidemiološke značajke te terapijski pristup u djece s brucelozom liječene u Klinici za infektivne bolesti Kliničke bolnice (KB) Mostar. Bolesnici i metode: Provedena je retrospektivna analiza podataka o kliničkim i epidemiološkim značajkama bruceloze prikupljenih iz medicinske dokumentacije bolesnika mlađih od 18 godina liječenih u Klinici za infektivne bolesti KB Mostar u razdoblju od 2005. do 2011. godine. Rezultati: U ispitivanom razdoblju u Klinici je liječeno ukupno 60 bolesnika s brucelozom, od čega devet (15%) djece. Djeca su većim dijelom bila iz ruralnih područja s pozitivnom epidemiološkom anamnezom (podatak o direktnom kontaktu s bolesnim životinjama, oboljelom članu obitelji i/ili konzumaciji mliječnih proizvoda iz domaćinstava u kojih je već bila dokazana bruceloza). U sve oboljele djece bruceloza je dokazana serološki, dok je pozitivnu hemokulturu imalo samo jedno dijete; taj izolat Brucella melitensis bio je rezistentan na trimetoprim-sulfametoksazol (TMP-SMZ). Najčešće kliničke manifestacije bile su vrućica, noćno znojenje, opća slabost, umor i gubitak apetita, a od laboratorijskih obilježja leukopenija i limfocitoza. Koštano-zglobni oblik bruceloze zabilježen je u 7/9 djece, najčešće monoartritis, dok respiratorni, genitourinarni, kožni, okularni i neurološki oblici bolesti nisu zabilježeni. Prosječno je liječenje bruceloze u oboljele djece trajalo 8,5 tjedana. Tijekom hospitalizacije liječenje je u svih provedeno kombinacijom gentamicina i rifampicina, dok je po otpustu peroralno liječenje nastavljeno kombinacijom rifampicina i azitromicina odnosno cefiksima u djece mlađe od osam godina, a kombinacijom rifampicina i doksiciklina u djece starije od osam godina. Izlječenje je postignuto u sve djece. Zaključak: U Bosni i Hercegovini bruceloza u djece je rijetka, ali ne i zanemariva bolest. Stoga svi liječnici koji rade u endemskim područjima trebaju diferencijalno-dijagnostički pomišljati na brucelozu u djece s dugotrajnom vrućicom, artralgijama i leukopenijom ukoliko dolaze iz ruralnih područja. Terapijski pristup u pedijatrijskoj populaciji daje različite mogućnosti kombiniranja antimikrobnih lijekova, no TMP-SMZ se ne čini kao razboriti izbor za empirijsko liječenje obzirom na dokazanu rezistenciju brucele na TMP-SMZ u naših bolesnika.Aim: Because of its socio-medical characteristics, brucellosis plays a significant role in the morbidity structure of Mediterranean countries, including Bosnia and Herzegovina. Brucellosis has a wide spectrum of clinical manifestations and can lead to a number of complications with severe sequelae. The purpose of this study was to analyze the clinical and epidemiological features and therapeutic approach in children treated for brucellosis at the Clinic for Infectious Diseases Mostar. Patients and methods: We conducted a retrospective analysis of clinical and epidemiological parameters collected from medical records of patients younger than 18 years of age treated for brucellosis at the Clinic for Infectious Diseases Mostar in the period 2005–2011. Results: Over the study period, a total of 60 patients with brucellosis were treated, of whom nine (15%) were children. The children mostly came from the rural areas with positive epidemiological history (records of direct contact with sick animals, sick family member and/or consumption of dairy products from households with confirmed cases of brucellosis). Brucellosis was confirmed by serology in all affected children, while only one child had positive blood culture and this isolate of Brucella melitensis was resistant to trimethoprim-sulfamethoxazole (TMP-SMZ). Most frequent clinical manifestations were fever, night sweats, general weakness, fatigue and loss of appetite, and laboratory findings of leukopenia and lymphocytosis. Osteoarticular form of brucellosis was recorded in 7/9 children, usually monoarthritis while respiratory, genitourinary, skin, ocular and neurological forms of the disease were not recorded. The average duration of brucellosis treatment in affected children was 8.5 weeks. During hospitalization all patients received a combination of gentamicin and rifampin, while after discharge from hospital children younger than eight years continued to take oral combination of rifampin and azithromycin or cefixime, and children older than eight years a combination of rifampin and doxycycline. Cure was achieved in all children. Conclusion: In Bosnia and Herzegovina brucellosis in children is rare, but it is not an insignificant disease. Therefore, all physicians working in endemic areas should consider brucellosis in the differential diagnosis in children with prolonged fever, arthralgias and leukopenia if coming from rural areas. Therapeutic approach in the pediatric population provides various possibilities for combining antimicrobials, however TMPSMZ does not seem like a prudent choice for empirical treatment considering Brucella resistance to TMP-SMZ in our patients

Epidemiological and clinical features of brucellosis in children

Cilj: U strukturi pobola mediteranskih zemalja, me|u koje spada Bosna i Hercegovina, bruceloza zauzima važno mjesto zbog svojih socijalno-medicinskih značajki. Bolest ima široki spektar kliničkih manifestacija i može dovesti do komplikacija s teškim posljedicama. Cilj ovog istraživanja bio je prikazati kliničke i epidemiološke značajke te terapijski pristup u djece s brucelozom liječene u Klinici za infektivne bolesti Kliničke bolnice (KB) Mostar. Bolesnici i metode: Provedena je retrospektivna analiza podataka o kliničkim i epidemiološkim značajkama bruceloze prikupljenih iz medicinske dokumentacije bolesnika mlađih od 18 godina liječenih u Klinici za infektivne bolesti KB Mostar u razdoblju od 2005. do 2011. godine. Rezultati: U ispitivanom razdoblju u Klinici je liječeno ukupno 60 bolesnika s brucelozom, od čega devet (15%) djece. Djeca su većim dijelom bila iz ruralnih područja s pozitivnom epidemiološkom anamnezom (podatak o direktnom kontaktu s bolesnim životinjama, oboljelom članu obitelji i/ili konzumaciji mliječnih proizvoda iz domaćinstava u kojih je već bila dokazana bruceloza). U sve oboljele djece bruceloza je dokazana serološki, dok je pozitivnu hemokulturu imalo samo jedno dijete; taj izolat Brucella melitensis bio je rezistentan na trimetoprim-sulfametoksazol (TMP-SMZ). Najčešće kliničke manifestacije bile su vrućica, noćno znojenje, opća slabost, umor i gubitak apetita, a od laboratorijskih obilježja leukopenija i limfocitoza. Koštano-zglobni oblik bruceloze zabilježen je u 7/9 djece, najčešće monoartritis, dok respiratorni, genitourinarni, kožni, okularni i neurološki oblici bolesti nisu zabilježeni. Prosječno je liječenje bruceloze u oboljele djece trajalo 8,5 tjedana. Tijekom hospitalizacije liječenje je u svih provedeno kombinacijom gentamicina i rifampicina, dok je po otpustu peroralno liječenje nastavljeno kombinacijom rifampicina i azitromicina odnosno cefiksima u djece mlađe od osam godina, a kombinacijom rifampicina i doksiciklina u djece starije od osam godina. Izlječenje je postignuto u sve djece. Zaključak: U Bosni i Hercegovini bruceloza u djece je rijetka, ali ne i zanemariva bolest. Stoga svi liječnici koji rade u endemskim područjima trebaju diferencijalno-dijagnostički pomišljati na brucelozu u djece s dugotrajnom vrućicom, artralgijama i leukopenijom ukoliko dolaze iz ruralnih područja. Terapijski pristup u pedijatrijskoj populaciji daje različite mogućnosti kombiniranja antimikrobnih lijekova, no TMP-SMZ se ne čini kao razboriti izbor za empirijsko liječenje obzirom na dokazanu rezistenciju brucele na TMP-SMZ u naših bolesnika.Aim: Because of its socio-medical characteristics, brucellosis plays a significant role in the morbidity structure of Mediterranean countries, including Bosnia and Herzegovina. Brucellosis has a wide spectrum of clinical manifestations and can lead to a number of complications with severe sequelae. The purpose of this study was to analyze the clinical and epidemiological features and therapeutic approach in children treated for brucellosis at the Clinic for Infectious Diseases Mostar. Patients and methods: We conducted a retrospective analysis of clinical and epidemiological parameters collected from medical records of patients younger than 18 years of age treated for brucellosis at the Clinic for Infectious Diseases Mostar in the period 2005–2011. Results: Over the study period, a total of 60 patients with brucellosis were treated, of whom nine (15%) were children. The children mostly came from the rural areas with positive epidemiological history (records of direct contact with sick animals, sick family member and/or consumption of dairy products from households with confirmed cases of brucellosis). Brucellosis was confirmed by serology in all affected children, while only one child had positive blood culture and this isolate of Brucella melitensis was resistant to trimethoprim-sulfamethoxazole (TMP-SMZ). Most frequent clinical manifestations were fever, night sweats, general weakness, fatigue and loss of appetite, and laboratory findings of leukopenia and lymphocytosis. Osteoarticular form of brucellosis was recorded in 7/9 children, usually monoarthritis while respiratory, genitourinary, skin, ocular and neurological forms of the disease were not recorded. The average duration of brucellosis treatment in affected children was 8.5 weeks. During hospitalization all patients received a combination of gentamicin and rifampin, while after discharge from hospital children younger than eight years continued to take oral combination of rifampin and azithromycin or cefixime, and children older than eight years a combination of rifampin and doxycycline. Cure was achieved in all children. Conclusion: In Bosnia and Herzegovina brucellosis in children is rare, but it is not an insignificant disease. Therefore, all physicians working in endemic areas should consider brucellosis in the differential diagnosis in children with prolonged fever, arthralgias and leukopenia if coming from rural areas. Therapeutic approach in the pediatric population provides various possibilities for combining antimicrobials, however TMPSMZ does not seem like a prudent choice for empirical treatment considering Brucella resistance to TMP-SMZ in our patients

Influence of pumpkin seed oil in continuous phase on droplet size and stability of water-in-oil emulsions

The aim of this work was to contribute to the optimized production of water-in-oil emulsions with pumpkin seed oil in the oil phase using a high-speed homogenizer. Pumpkin seed oil is a valuable natural source of essential fatty acids and biologically active micronutrients that contribute to its nutritive value and medical uses, and reduce interfacial tension between water and the oil phases. Therefore, pumpkin seed oil can be considered as a prosperous oil phase whose use can possibly decrease the amount of some emulsifier that is normally involved in every emulsification process. A central composite rotatable experimental design was implemented to analyze the impact of the contents of polyglycerol polyricinoleate and pumpkin seed oil in the continuous phase, as well as water phase content in the emulsion on droplet size distribution and the response surface methodology was used to obtain optimal conditions for water-in-oil emulsion preparation. Mean size diameter of water droplets was in a range from 400 to 850 nm, with mean peak width of 100 to 220 nm, respectively. The influence of all three investigated factors on the emulsification was determined. Additionally, the emulsions prepared with pumpkin seed oil showed a higher stability during the storage time compared to the emulsions with sunflower oil

The Occurrence of Hemorrhagic Fever with Renal Syndrome in Southern Parts of Bosnia and Herzegovina

Bosnia and Herzegovina (B&H) has been known as an endemic region for hemorrhagic fever with renal syndrome (HFRS) for over 50 years. Multiple epidemics of this disease have been registered so far, especially in endemic parts of Central and Northeastern Bosnia, as well as the Sarajevo region. Seroepidemiological investigations demonstrate naturalization of Hantaviruses and their wide spread in B&H. However, there are no studies from the southern areas of B&H, and endemic foci of this disease are unknown. The aim of this study was to determine the distribution and serologic prevalence of Hantavirus infections by testing for specific IgG antibodies against hantaviruses in the population of Herzegovina. This study included two groups of participants. The target group consisted of 300 participants from exposed professional and population groups, and control group included 100 educators with lower exposure to HFRS. Identification of specific IgG antibodies against hantaviruses in 16 participants confirmed an initial assumption about the presence of Hantavirus infections in the region of interest. Seroprevalence of 5% was registered in the »exposed« and 1% in the »unexposed« group. Simultaneous circulation of Puumala (PUU) and Dobrava (DOB) viruses was discovered. The frequency of positive antibody results was higher in the population above 50 years of age, and three times more prevalent in men then at women. The highest proportion of exposed participants (80%) was registered in the municipalities which geographically belong to high or mountainous Herzegovina

Cardiac Arrest in a Patient with Ebstein’s Anomaly without Accessory Pathways

We describe a case report of a patient with cardiac arrest and Ebstein’s anomaly. This case report shows us necessity for arrhythmia evaluation and sudden death risk stratification even in asymptomatic patients. Prophylactic ICD im- plantation in this patient population is limited to observational studies and the selection of patients is impeded by the absence of randomized trials and weak predictors